Danno renale e infezione da Mycoplasma pneumoniae: ipotesi ragionata e revisione della letteratura

Mycoplasma pneumoniae is a well-recognized pathogen responsible for community-acquired respiratory infections, particularly atypical pneumonia. Beyond its respiratory involvement, this microorganism is often associated with extra-respiratory manifestations. However, available reviews only marginally address the potential occurrence of kidney injury. The aim of this study was to investigate the relationship between Mycoplasma pneumoniae and kidney disease through expert analysis and a comprehensive literature review. Four possible mechanisms underlying kidney injury were identified: cardiorenal syndrome; pigment nephropathy resulting from hemolysis or rhabdomyolysis; “direct” kidney injury including interstitial nephritis, IgA mediated nephropathy, or hemolytic uremic syndrome; nephrotoxicity caused by medications used to treat Mycoplasma pneumoniae infection or to relieve symptoms. Renal impairment associated with Mycoplasma pneumoniae predominantly occurs during the infection rather than as a post-infectious complication. This renal impairment is probably caused directly by Mycoplasma pneumoniae, cytokines, or by immunologically mediated mechanisms characteristic of the early immune response. This study highlights the need for clinicians to consider renal complications in patients with Mycoplasma pneumoniae, particularly those presenting with systemic symptoms.