Subacute infectious endocarditis-associated membranoproliferative glomerular nephritis: A Case Report and Review
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Abstract
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.
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Baehr G. Glomerular lesions of subacute bacterial endocarditis. J Exp Med. 1912; 15: 330-347. Ref.: https://goo.gl/AMUHUw
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
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
Couser WG, Johnson RJ. The etiology of glomerulonephritis: roles of infection and autoimmunity. Kidney Int. 2014; 86: 905-914. Ref.: https://goo.gl/72DX5E
Naber CK, Erbel R. Infective endocarditis with negative blood cultures. Int J Antimicrob Agents. 2007; 30: 32‑36. Ref.: https://goo.gl/oHVfaC
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: 407‑410. Ref.: https://goo.gl/ztqBVN
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
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
Neugarten J, Baldwin DS. Glomerulonephritis in bacterial endocarditis. Am J Med. 1984; 77: 297-304. Ref.: https://goo.gl/7FxBTK
Kannan S, Mattoo TK. Diffuse crescentic glomerulonephritis in bacterial endocarditis. Pediatr Nephrol. 2001; 16: 423‑428. Ref.: https://goo.gl/KxEBSP
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
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