Acute Kidney Injury and Hemolytic Anemia Secondary to Mycoplasma pneumoniae Infection

Nephron. 2017;137(2):148-154. doi: 10.1159/000478991. Epub 2017 Jul 7.


Glomerulonephritis as well as kidney injury secondary to fulminant intravascular hemolysis are rare extrapulmonary manifestations of Mycoplasma pneumoniae infection. We describe a 50-year-old female diagnosed with M. pneumoniae infection-associated hemolytic anemia, characterized by negative cold agglutinin tests but with laboratory evidence of complement alternative pathway activation. The patient presented both with anemia and severe kidney failure and she was treated with steroids and red blood cell transfusions along with plasmapheresis. She also received a short course of antibiotics. Renal biopsy showed combined features of resolving postinfectious glomerulonephritis and hemolysis-associated extensive acute tubular injury characterized by renal hemosiderosis and intratubular hemoglobin casts. Electron microscopy revealed features of glomerular microangiopathic injury. The treatment led to complete disease remission and a favorable renal outcome at the first year follow-up.

Keywords: Glomerulonephritis; Hemolysis; Hemolytic uremic syndrome; Intratubular hemoglobin casts; Microangiopathy; Mycoplasma pneumoniae; Renal biopsy; Renal failure; Renal hemosiderosis.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / pathology
  • Anemia, Hemolytic / etiology*
  • Anti-Bacterial Agents / therapeutic use
  • Female
  • Glomerulonephritis / etiology
  • Hemoglobins / metabolism
  • Hemosiderosis / etiology
  • Humans
  • Kidney / pathology
  • Kidney Failure, Chronic / complications
  • Middle Aged
  • Mycoplasma pneumoniae*
  • Pneumonia, Mycoplasma / complications*
  • Pneumonia, Mycoplasma / drug therapy
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Hemoglobins