Abstract

Case Report

Subacute infectious endocarditis-associated membranoproliferative glomerular nephritis: A Case Report and Review

Yi De Zhang, Ya Min Yu, Hou Yong Dai, Xiao Lan Chen, Li Yuan and Hui Shi*

Published: 17 August, 2017 | Volume 2 - Issue 1 | Pages: 052-055

We experienced a case of membranoproliferative glomerulonephritis (MPGN) caused by subacute infectious endocarditis (SIE). A 57-year-old male farmer complained of fatigue, lack of appetite and gross haematuria for a month; he had no cough, chest pain, or exertion dyspnea. After admission, lab tests showed mild proteinuria(1.04g/d) and heavy dysmorphic red blood cells(RBC) (543/HP), with serum creatinine(Scr) slightly elevated(1.46mg/dl) and anemia(hemoglobin Hb 85g/L). A renal biopsy revealed MPGN lesion with 16.6% cellular crescents. The echocardiogram test revealed mitra valve prolapse with perforation of the anterior lobe, vegetation, and severe regurgitation. He was diagnosed as SIE induced MPGN. Then he underwent mitral valve replacement after systemic antibiotic treatment without immunosuppressive agents. Follow-up showed that he dramatically regained normal kidney function in total 1 year after the operation. Thus, antibiotic administration and valve replacement may be efficient enough for some of SIE induced MPGN. We did a brief review of the literature on SIE induced MPGN, which was sometimes misdiagnosed due to its silent characteristics; some SIE patients may initially have other organs involved.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001014 Cite this Article Read Full Article PDF

Keywords:

Subacute infectious endocarditis; Membranoproliferative glomerulonephritis; Acute renal failure; Antibiotics; Mitral valve replacement

References

  1. Baehr G. Glomerular lesions of subacute bacterial endocarditis. J Exp Med. 1912; 15: 330-347. Ref.: https://goo.gl/AMUHUw
  2. Zhang YD, Dai HY, Xie HL, Zhou QL, Liu ZH. The role of renal damage on cardiac remodeling in patients with diabetic nephropathy. Clin Nephrol. 2013; 80: 249-255. Ref.: https://goo.gl/chLL8F
  3. Zhang Y, Peng W, Ao X, Dai H, Yuan L, Huang X, et al. TAK-242, a Toll-Like Receptor 4 Antagonist, Protects against Aldosterone-Induced Cardiac and Renal Injury. PLoS ONE. 2015; 10: e0142456. Ref.: https://goo.gl/Tx45dr
  4. Couser WG, Johnson RJ. The etiology of glomerulonephritis: roles of infection and autoimmunity. Kidney Int. 2014; 86: 905-914. Ref.: https://goo.gl/72DX5E
  5. Naber CK, Erbel R. Infective endocarditis with negative blood cultures. Int J Antimicrob Agents. 2007; 30: 32‑ Ref.: https://goo.gl/oHVfaC
  6. Buchholtz K, Larsen CT, Hassager C, Bruun NE. In infectious endocarditis patients mortality is highly related to kidney function at time of diagnosis: a prospective observational cohort study of 231 cases. Eur J Intern Med. 2009; 20: 407‑ Ref.: https://goo.gl/ztqBVN
  7. Bor DH, Woolhandler S, Nardin R, Brusch J, Himmelstein DU. Infective endocarditis in the U.S. 1998-2009: a nationwide study. PLoS One. 2013; 8: e60033. Ref.: https://goo.gl/gGjGVt
  8. Boils CL, Nasr SH, Walker PD, Couser WG, Larsen CP. Update on endocarditis-associated glomerulonephritis. Kidney International. 2015; 87: 1241-1249. Ref.: https://goo.gl/UgV7Jg
  9. Neugarten J, Baldwin DS. Glomerulonephritis in bacterial endocarditis. Am J Med. 1984; 77: 297-304. Ref.: https://goo.gl/7FxBTK
  10. Kannan S, Mattoo TK. Diffuse crescentic glomerulonephritis in bacterial endocarditis. Pediatr Nephrol. 2001; 16: 423‑ Ref.: https://goo.gl/KxEBSP
  11. Krishnamurthy S, Chandrasekaran V, Mahadevan S, Priyamvada PS, Rajesh NG. Severe acute kidney injury in children owing to infective endocarditis-associated immune complex glomerulonephritis: a report of two cases. Paediatr Int Child Health. 2017; 37: 144-147. Ref.: https://goo.gl/mZB7eo
  12. Manzoor K, Khan S, Ahmed E, Akhter F, Mubarak M, et al. Crescentic glomerulonephritis associated with bacterial endocarditis-Antibiotics alone may be sufficient. A case report. J Pak Med Assoc. 2005; 55: 352-354. Ref.: https://goo.gl/3Zwe4P

Figures:

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