Is spinal epidural abscess related to IgA (Immunoglobulin A) nephropathy?

No Direct Connection Between Spinal Epidural Abscess and IgA Nephropathy

There is no established pathophysiologic connection between spinal epidural abscess (SEA) and IgA nephropathy—these are distinct disease entities that can rarely occur together as coincidental complications of severe systemic infection.

Understanding the Relationship

IgA Nephropathy as a Primary Renal Disease

• IgA nephropathy is the most common primary glomerulonephritis, characterized by mesangial dominant or co-dominant IgA deposits in the kidney 1
• The pathogenesis involves dysregulation of the mucosal immune system leading to undergalactosylation of IgA, formation of IgG autoantibodies, and subsequent immune complex deposition in the mesangium 2
• IgA nephropathy is diagnosed by kidney biopsy showing characteristic IgA-dominant immunofluorescence staining 1

Infection-Related IgA Nephropathy: The Key Link

• IgA-dominant infection-related glomerulonephritis can occur with Staphylococcus aureus infections, which is the most common pathogen in SEA (63.6-70.7% of cases) 1, 3, 4
• The Mayo Clinic/Renal Pathology Society specifically recognizes "IgA-dominant infection-related GN" as a distinct entity associated with S. aureus cellulitis infection 1
• This represents a secondary form of IgA nephropathy triggered by severe bacterial infection, not the primary idiopathic disease 2

The Single Documented Case

COVID-19 as the Common Trigger

• One case report documented a patient who developed both IgA nephropathy and spinal epidural abscess following COVID-19 infection 5
• This 56-year-old male developed severe back pain and gross hematuria approximately one month after COVID-19 hospitalization, with renal biopsy confirming IgA nephropathy and imaging revealing epidural abscess 5
• This represents coincidental complications of severe systemic infection rather than a direct causal relationship between the two conditions 5

Clinical Implications

When to Consider the Association

• In patients with SEA who develop acute kidney injury with hematuria and proteinuria, consider infection-related glomerulonephritis 5
• S. aureus SEA can trigger IgA-dominant infection-related GN through immune complex formation during severe systemic infection 1
• Secondary causes of IgA nephropathy including infections should always be identified or ruled out 2

Diagnostic Approach

• Kidney biopsy is mandatory to diagnose IgA nephropathy and distinguish primary from infection-related disease 1, 2
• The pattern showing "IgA-dominant infection-related GN" with diffuse exudative glomerulonephritis suggests secondary disease associated with bacterial infection 1
• Clinical correlation with active infection (such as SEA) should be documented in the pathology report 1

Management Priorities

• Treat the underlying infection (SEA) as the primary intervention, as resolution of infection-related glomerulonephritis depends on controlling the infectious source 6
• SEA requires urgent surgical decompression in patients with neurological deficits, combined with appropriate antibiotics 7, 3, 4
• Medical management alone for SEA is only appropriate for neurologically intact patients without specific risk factors for treatment failure 7, 4

Important Caveats

• The vast majority of IgA nephropathy cases are primary (idiopathic) and unrelated to SEA 1, 2
• The vast majority of SEA cases do not cause IgA nephropathy 3, 4
• When both conditions coexist, consider severe systemic infection (particularly S. aureus) as the unifying trigger rather than a direct pathophysiologic link 1, 5