THE WISDOM IN A TOOTH: A POSSIBLE PRECIPITANT FOR POST-STREPTOCOCCAL GLOMERULONEPHRITIS
Dr Catherine Mao1,2, Associate Professor Bobby Chacko1,2
1Nephrology and Transplantation Unit, John Hunter Hospital, Newcastle, Australia, 2School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
Background: Post-streptococcal glomerulonephritis (PSGN) is an inflammatory kidney disease caused by beta-haemolytic streptococcus infection, classically of the pharynx or skin. It is uncommon among adults, and more prevalent in children and within Aboriginal and Torres Strait Islander communities. PSGN and post-infectious glomerulonephritis have also been described following dental infections. However, it has not been linked with non-infected dental procedures. Dental procedures and even tooth brushing may precipitate transient bacteraemia, which forms the plausible pathogenic link.
Case Report: A 19-year-old Caucasian male presented 5 days after an uncomplicated non-infected wisdom tooth extraction with acute kidney injury (AKI) (creatinine 410umol/L, baseline 88umol/L), hypertension, microscopic haematuria and macroalbuminuria. This was associated with 2 days of flank pain, vomiting and diarrhoea. He was afebrile. Following the procedure, he completed a course of amoxicillin and one dose of ibuprofen. The AKI did not improve with intravenous rehydration. A kidney biopsy was planned suspecting acute interstitial nephritis, but did not proceed due to expected imminent AKI recovery, with down-trending creatinine (357umol/L) and robust urine output at the time of the procedure. Investigations for glomerulonephritis found rising streptococcal antibody titres, with anti-DNAse B returning positive at day 6 and ASO titre positive at week 3. This was consistent with recent streptococcal infection and leading to the diagnosis of probable PSGN. He has had excellent renal recovery, with creatinine 94umol/L 10 weeks later.
Conclusions: This case highlights an unusual presentation of probable PSGN, in a low-risk population group and in absence of a classical streptococcal infection. The disruption of oral mucosa during a dental procedure can be sufficient to cause streptococcal infection, and so PSGN should be additionally considered in these clinical contexts.
Biography:
First year Nephrology Advanced Trainee at John Hunter Hospital.