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Getachew Y, Getahun Z, Wondafrash G, Asmare Z, Solela G, Aberra B, Daba M. Native and prosthetic valve infective endocarditis complicated by rapidly progressive glomerulonephritis and its diagnostic challenges and therapeutic implications. Clin Case Rep 2024; 12:e9054. [PMID: 38868123 PMCID: PMC11166548 DOI: 10.1002/ccr3.9054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
Key Clinical Message Concomitant native and prosthetic valve infective endocarditis (IE) is very rare, and both can rarely be complicated by rapidly progressive glomerulonephritis (RPGN). This diagnosis has therapeutic implications, as not all RPGN need immunosuppression therapy. Abstract Native and prosthetic valve infective endocarditis (IE) may be rarely complicated by rapidly progressive glomerulonephritis (RPGN). The diagnosis of IE as a cause of RPGN may be missed, and patients may be subjected to inappropriate immune suppressive therapy. Moreover, IE involving multi-valves has rarely been described, and there are only few case reports of simultaneous native and prosthetic valve endocarditis. Here, we present a case of 34-year-old female patient who has RPGN and whose initial workup missed IE. However, further workup revealed a diagnosis of native and prosthetic valve IE and our patient, who would have been subjected to inappropriate immune suppressive therapy, was treated with intravenous antibiotics alone and discharged with improvement.
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Affiliation(s)
- Yitagesu Getachew
- Cardiology Unit, Department of Internal MedicineYekatit 12 Hospital Medical CollegeAddis AbabaEthiopia
| | - Zerubabel Getahun
- Department of Internal Medicine, School of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Getachew Wondafrash
- Division of Nephrology, Department of Internal MedicineYekatit 12 Hospital Medical CollegeAddis AbabaEthiopia
| | - Zemenay Asmare
- Department of Internal MedicineYekatit 12 Hospital Medical CollegeAddis AbabaEthiopia
| | - Gashaw Solela
- Department of Internal MedicineYekatit 12 Hospital Medical CollegeAddis AbabaEthiopia
| | - Beka Aberra
- Division of Nephrology, Department of Internal Medicine, School of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Merga Daba
- Department of Internal Medicine, School of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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2
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Takahashi G, Watanabe T, Satoh T. Infective Endocarditis Caused by Streptococcus sanguinis Resulting in Stroke, Ruptured Infected Pseudoaneurysm of Superior Mesenteric Artery, and Rapidly Progressive Glomerulonephritis. Intern Med 2024; 63:413-417. [PMID: 37344426 PMCID: PMC10901719 DOI: 10.2169/internalmedicine.2017-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
A 71-year-old-man was admitted to our hospital with a cerebral embolism and diagnosed with infective endocarditis (IE) caused by Streptococcus sanguinis. Mitral valve replacement was performed. About one month later, he experienced sudden abdominal pain and shock due to a ruptured infected mesenteric artery pseudoaneurysm. Forty-four days after abdominal surgery, he presented with rapidly progressive glomerulonephritis with anti-glomerular basement membrane antibodies. He was treated with plasma exchange and prednisolone, and his renal function gradually improved. Since postoperative complications often occur within a few years after surgery for IE, careful follow-up is important, even after antimicrobial therapy and valve surgery.
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Affiliation(s)
- Go Takahashi
- Division of Internal Medicine, Health Co-op. Watari Hospital, Japan
| | - Tomoyuki Watanabe
- Division of Cardiology and Internal Medicine, Health Co-op. Watari Hospital, Japan
| | - Takeshi Satoh
- Division of Rehabilitation, Internal Medicine, Health Co-op. Watari Hospital, Japan
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3
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Springer JM, Villa-Forte A. Vasculitis Mimics and Other Related Conditions. Rheum Dis Clin North Am 2023; 49:617-631. [PMID: 37331736 DOI: 10.1016/j.rdc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The approach to diagnosis of primary systemic vasculitis can be challenging, often requiring consideration of important secondary causes of vasculitis and non-inflammatory mimics. An atypical pattern of vascular involvement and/or atypical features of primary vasculitis (eg, cytopenia, lymphadenopathy) should prompt a more thorough investigation into other diseases. Herein, we review selected mimics organized by the size of blood vessels typically affected.
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Affiliation(s)
- Jason M Springer
- Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 Medical Center North, Nashville, TN 37232-2681, USA.
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4
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Canetta PA. Right Heart, Wronged Kidneys. Clin J Am Soc Nephrol 2023; 18:813-815. [PMID: 36988331 PMCID: PMC10278778 DOI: 10.2215/cjn.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Pietro A Canetta
- Nephrology Division, Columbia University Irving Medical Center, New York, New York
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5
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Takayasu M, Hirayama K, Shimohata H, Kobayashi M, Koyama A. Staphylococcus aureus Infection-Related Glomerulonephritis with Dominant IgA Deposition. Int J Mol Sci 2022; 23:ijms23137482. [PMID: 35806487 PMCID: PMC9267153 DOI: 10.3390/ijms23137482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Since 1995, when we reported the case of a patient with glomerulonephritis with IgA deposition that occurred after a methicillin-resistant Staphylococcus aureus (MRSA) infection, many reports of MRSA infection-associated glomerulonephritis have accumulated. This disease is being systematized as Staphylococcus infection-associated glomerulonephritis (SAGN) in light of the apparent cause of infection, and as immunoglobulin A-dominant deposition infection-related glomerulonephritis (IgA-IRGN) in light of its histopathology. This glomerulonephritis usually presents as rapidly progressive glomerulonephritis or acute kidney injury with various degrees of proteinuria and microscopic hematuria along with an ongoing infection. Its renal pathology has shown several types of mesangial and/or endocapillary proliferative glomerulonephritis with various degrees of crescent formation and tubulointerstitial nephritis. IgA, IgG, and C3 staining in the mesangium and along the glomerular capillary walls have been observed on immunofluorescence examinations. A marked activation of T cells, an increase in specific variable regions of the T-cell receptor β-chain-positive cells, hypercytokinemia, and increased polyclonal immune complexes have also been observed in this glomerulonephritis. In the development of this disease, staphylococcal enterotoxin may be involved as a superantigen, but further investigations are needed to clarify the mechanisms underlying this disease. Here, we review 336 cases of IgA-IRGN and 218 cases of SAGN.
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Affiliation(s)
- Mamiko Takayasu
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
- Correspondence: ; Tel.: +81-29-887-1161
| | - Homare Shimohata
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Masaki Kobayashi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Akio Koyama
- Emeritus Professor, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan;
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6
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Al Zein S, Shueib A, Alqudsi M. A Case of Immunoglobulin A (IgA)-Dominant Infection-Related Glomerulonephritis Treated With Plasmapheresis. Cureus 2022; 14:e22916. [PMID: 35399483 PMCID: PMC8986500 DOI: 10.7759/cureus.22916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IRGN) is mostly associated with Staphylococcal or other bacterial infections like Streptococcus and Gram-negative bacilli. Antibiotics are the cornerstone of treatment in these cases. When the bacterial infection can’t be recognized or IRGN persists despite treating the underlying infection, controlling the kidney injury becomes cumbersome and lacks a strong evidence-based approach. In this report, we describe a 38-year-old male patient with a history of polysubstance abuse and chronic hepatitis B and hepatitis C infections who presented with acute kidney injury and nephrotic syndrome due to IgA-dominant IRGN without an active concurrent bacterial infection who responded well to plasmapheresis.
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7
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Takata T, Mae Y, Sugihara T, Isomoto H. Infective Endocarditis-Associated Glomerulonephritis: A Comprehensive Review of the Clinical Presentation, Histopathology, and Management. Yonago Acta Med 2022; 65:1-7. [DOI: 10.33160/yam.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Tomoaki Takata
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yukari Mae
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takaaki Sugihara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Jamme M, Oliver L, Ternacle J, Lepeule R, Moussafeur A, Haymann JP, San S, Fiore A, Mongardon N, Daudon M, Lim P, Letavernier E. Amoxicillin crystalluria is associated with acute kidney injury in patients treated for acute infective endocarditis. Nephrol Dial Transplant 2021; 36:1955-1958. [PMID: 33848352 DOI: 10.1093/ndt/gfab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/21/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthieu Jamme
- Urgence Néphrologique et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
- Centre de Recherche en Epidémiologie et Santé des Populations, Equipe "Epidemiologie Clinique", INSERM U1018, Université Paris Saclay, Villejuif, France
| | - Leopold Oliver
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Julien Ternacle
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Raphael Lepeule
- Unité SOS Endocardite, Equipe Mobile D'infectiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Amina Moussafeur
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Jean-Philippe Haymann
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
| | - Sovannarith San
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Antonio Fiore
- Unité SOS Endocardite, Service de Chirurgie Cardiaque, Hôpital Henri Mondor, APHP, Créteil, France
| | - Nicolas Mongardon
- Unité SOS Endocardite, Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, APHP, Créteil, France
| | - Michel Daudon
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
| | - Pascal Lim
- Unité SOS Endocardite, Service de Cardiologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Emmanuel Letavernier
- Explorations Fonctionnelles Rénales, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM, Paris, France
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9
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Shaikh G, Gosmanova EO, Rigual-Soler N, Der Mesropian P. Systemic Bartonellosis Manifesting With Endocarditis and Membranoproliferative Glomerulonephritis. J Investig Med High Impact Case Rep 2021; 8:2324709620970726. [PMID: 33155512 PMCID: PMC7656866 DOI: 10.1177/2324709620970726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cat scratch disease caused by Bartonella species is mostly benign and self-limiting condition. Systemic infection is uncommon in immunocompetent host. We describe the case of a 66-year-old male who presented with sudden painless left eye blindness and brown-colored urine. Laboratory findings revealed progressively rising serum creatinine in association with nephrotic-range proteinuria at 7 g/day and glomerular hematuria on urinalysis. An echocardiogram demonstrated mitral and tricuspid valve vegetations despite multiple negative blood cultures. The left eye blindness was attributed to retinal artery occlusion from septic valvular embolus. Kidney biopsy showed membranoproliferative glomerulonephritis pattern of injury with "full house" pattern on immunofluorescent staining with subendothelial deposits on electron microscopy. Markedly elevated IgG (immunoglobulin G) titers for B henselae and B quintana were discovered. The patient had several cats at home. Kidney failure rapidly progressed to require hemodialysis. Once the diagnosis of systemic bartonellosis was confirmed, doxycycline (for 4 months) with rifampicin (for 3 months) were initiated. Repeat echocardiogram in 4 months demonstrated a resolution of valvular vegetations; however, the left eye blindness was permanent. In the present case the correct diagnosis of systemic bartonellosis allowed institution of appropriate antibiotic therapy and to also achieve a partial recovery of renal function and to discontinue hemodialysis.
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Affiliation(s)
- Gulvahid Shaikh
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| | - Elvira O Gosmanova
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| | | | - Paul Der Mesropian
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
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Eid MM. Infective endocarditis with embolic renal infarct presenting as acute abdomen. Clin Exp Emerg Med 2021; 8:145-148. [PMID: 34237820 PMCID: PMC8273678 DOI: 10.15441/ceem.20.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Infective endocarditis (IE) is a disease that is rare but potentially fatal and challenging to diagnose. A 28-year-old man with sickle cell trait and a history of intravenous drug use presented with abdominal pain and hematuria mimicking a surgical abdomen. The preliminary diagnosis was cholecystitis or perforated viscus. The chest radiograph was indicative of pulmonary septic emboli. Computed tomography was initially thought to show pyelonephritis, but further review of images revealed renal infarct. The patient was found to have endocarditis which resulted in an embolic renal infarct. The patient recovered remarkably well after 60 days of intravenous antibiotics. This case demonstrates that a surgical abdomen may also be a sign of endocarditis, and multiple imaging studies may be required to confirm the diagnosis. In patients such as intravenous drug users with an increased risk of IE, unexplained flank pain should raise a suspicion of acute renal infarction.
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11
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Bartonella-Associated Endocarditis with Severe Active Crescentic Glomerulonephritis and Acute Renal Failure. Case Rep Nephrol 2021; 2021:9951264. [PMID: 34194856 PMCID: PMC8181106 DOI: 10.1155/2021/9951264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
We report a case of severe acute kidney failure due to crescentic glomerulonephritis who presented initially with culture-negative endocarditis with vegetations on the aortic valve. Anti-nuclear and anti-phospholipid antibodies were positive with initially negative anti-neutrophil cytoplasmic antibodies (ANCAs). Kidney biopsy revealed severe acute crescentic glomerulonephritis with mesangial immune complex deposition. PR3-ANCA subsequently become positive, and the patient developed worsening kidney failure requiring hemodialysis. This case illustrates that Bartonella can present as culture-negative endocarditis with severe crescentic glomerulonephritis with positive PR-3 ANCAs and can mimic ANCA-associated crescentic glomerulonephritis.
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12
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Petersen JK, Jensen AD, Bruun NE, Kamper AL, Butt JH, Havers-Borgersen E, Chaudry MS, Torp-Pedersen C, Køber L, Fosbøl EL, Østergaard L. Outcome of Dialysis-Requiring Acute Kidney Injury in Patients With Infective Endocarditis: A Nationwide Study. Clin Infect Dis 2021; 72:e232-e239. [PMID: 32687184 DOI: 10.1093/cid/ciaa1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. METHODS Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis-naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed 1 year postdischarge. Multivariable adjusted Cox proportional hazard analysis was used to examine 1-year mortality for patients surviving IE according to use of dialysis. RESULTS We included 7307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with nondialysis patients (47.4% vs 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n = 197), 153 (77.7%) initiated dialysis on or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (P < .0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within 1 year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased 1-year mortality from IE discharge, hazard ratio = 1.64 (95% confidence interval, 1.21-2.23). CONCLUSION In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximate 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.
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Affiliation(s)
| | | | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark.,Clinical Institutes, Copenhagen and Aalborg Universities, Denmark
| | | | - Jawad Haider Butt
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Mavish S Chaudry
- Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
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Khalighi MA, Chang A. Infection-Related Glomerulonephritis. GLOMERULAR DISEASES 2021; 1:82-91. [PMID: 36751423 PMCID: PMC9677723 DOI: 10.1159/000515461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
Background There has been a long, storied relationship between various bacterial infections and glomerular injury, which is now encompassed under the term of infection-related glomerulonephritis (GN). The clinical and pathologic manifestations vary depending on the duration, magnitude, and underlying pathogen associated with the inciting infectious process. A brief and acute episode may lead to a self-limiting glomerular manifestation while a chronic or repetitive infection can result in persistent and irreversible injury. In this review, we will discuss the clinical and pathologic findings associated with the infection-related glomerulonephritides. Summary An acute exudative GN with an influx of neutrophils is the most characteristic morphologic alteration associated with infection-related glomerular injury. The immunofluorescence staining pattern often reveals prominent complement component C3 deposition in both capillary walls and mesangial regions with or without accompanying immunoglobulin. Large subepithelial electron-dense deposits known as "humps" are the hallmark ultrastructural finding; however, these features can also be present in C3 glomerulopathies, which are often triggered by infections and may have similar underlying abnormalities in alternative pathway complement activation. In addition, other glomerular injuries can simultaneously be present along with infection-related GN, such as diabetic nephropathy, lupus nephritis, or immunoglobulin A nephropathy, constituting a true diagnostic challenge for the pathologist. Key Messages Bacterial infection-related GN represents a spectrum of glomerular injury with variable clinical and pathologic presentations. The pathologic findings can show overlap with other glomerular diseases, and different forms of infection-related GN vary in terms of prognosis and treatment approach.
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Affiliation(s)
- Mazdak A. Khalighi
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Anthony Chang
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA,*Anthony Chang,
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14
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Manalili SA, So PN, Naidas MAL, Villanueva AR. Crescentic postinfectious glomerulonephritis in an adult patient with juvenile nasopharyngeal angiofibroma. BMJ Case Rep 2021; 14:14/4/e242785. [PMID: 33893138 PMCID: PMC8074561 DOI: 10.1136/bcr-2021-242785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Crescentic glomerulonephritis is usually associated with an acute nephritic syndrome with rapidly declining renal function. Postinfectious cases usually have a higher possibility of recovery. Juvenile nasopharyngeal angiofibroma (JNA) is a rare, locally aggressive tumour affecting mostly young men. A 28-year-old man presented with recurrent JNA initially excised 2 years prior. The patient was initially managed as a case of airway obstruction and pneumonia. He developed tea-coloured urine, oedema and acute kidney failure requiring dialysis while awaiting surgery. Urine and immunological studies (low C3, negative antineutrophil cytoplasmic antibody and antinucleosomal antibody and high antistreptolysin O) suggested a nephritic aetiology. Nasopharyngeal swab cultures of the mass revealed gram-negative organisms. Kidney biopsy showed diffuse proliferative glomerulonephritis compatible with a postinfectious glomerulonephritis with 77% cellular crescents. The mass was excised with histopathology consistent with JNA. The patient was eventually discharged off dialysis.
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Affiliation(s)
- Sheryll Anne Manalili
- Division of Nephrology, Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Paolo Nikolai So
- Division of Nephrology, Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Maria Ana Louise Naidas
- Division of Nephrology, Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Anthony Russell Villanueva
- Division of Nephrology, Department of Medicine, University of the Philippines Manila, Manila, Philippines
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Kobayashi S, Kakeshita K, Imamura T, Fujioka H, Yamazaki H, Koike T, Kinugawa K. Clinical Implications of Steroid Therapy for Crescentic Glomerulonephritis and Gemella morbillorum-associated Infective Endocarditis. Intern Med 2021; 60:299-303. [PMID: 32921686 PMCID: PMC7872803 DOI: 10.2169/internalmedicine.5319-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 54-year-old man was admitted to our institute with a diagnosis of infective endocarditis (IE) with vegetation on the mitral valve and severe regurgitation due to Gemella morbillorum infection together with renal dysfunction, which was eventually diagnosed as infection-related pauci-immune necrotizing crescentic glomerulonephritis. Given the refractoriness to antibiotics, the persistent activity of nephritis, and repeated cerebral hemorrhaging, we prioritized steroid therapy over early surgical mitral valve replacement. Following steroid therapy, the glomerulonephritis completely improved. Although the administration of steroid therapy in the active phase of IE remains controversial, it might be indicated if comorbid glomerulonephritis is critical.
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Affiliation(s)
- Shiori Kobayashi
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Japan
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16
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Golas VL, Lao KM, Misuraca MS, Li W, Marrone MG, Kanaan HD, Zhang PL. The clinical features of overlap syndrome (ANCA-associated crescentic glomerulonephritis [AACGN] and immune complex-mediated glomerulonephritis) are similar to those of AACGN alone. Int Urol Nephrol 2020; 53:515-521. [PMID: 33025405 DOI: 10.1007/s11255-020-02654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
The overlap syndromes of anti-neutrophil cytoplasmic antibodies (ANCA)-associated crescentic glomerulonephritis (AACGN) and variants of immune complex medicated glomerulopathy (ICMGN) have been reported. But very few have compared AACGN alone with the overlap syndromes (AACGN plus ICMGN). The aim of this retrospective study was to make that comparison, following serum creatinine (sCr) to determine whether the two groups (AACGN-only group versus overlap group) would behave differently over time. We identified 14 cases with dual diagnoses of AACGN and various ICMGN in the overlap group. Data were collected and compared with 15 randomly selected AACGN-only cases over the similar period of time. The overlap syndrome represented 0.35% of our overall biopsies (14/4049). All 14 patients were ANCA positive and had crescentic formation. The percentage of crescents in the biopsies ranged from 10 to 78%. ICMGN included the following: membranoproliferative glomerulonephritis, post-infectious glomerulonephritis, membranous glomerulopathies, idiopathic mesangial proliferative glomerulonephritis, lupus nephritis, and IgA nephropathy. With the exception one biopsy revealing lupus nephritis class III, most of the ICMGN were mild. When compared to the AACGN-only group, there were no significant differences in clinical and histologic indices including age, percent of crescents, and sCr (on biopsy days, and over the follow-up periods), although the numbers of follow-up cases were limited over time. Our findings suggest that AACGN was the dominant disease process in the majority of overlap syndromes between AACGN and ICMGN, similar to the clinical processes of AACGN-only disease, therefore, the AACGN in overlap syndrome cases should be the main target for clinical management.
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Affiliation(s)
- Victoria L Golas
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Kriselle Maris Lao
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Michael S Misuraca
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Wei Li
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Mark G Marrone
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Hassan D Kanaan
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Ping L Zhang
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA. .,Division of Anatomic Pathology, William Beaumont Hospital, Beaumont LaboratoryRoyal Oak, MI, 48073, USA.
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Yamashita S, Tago M, Tokushima M, Nakashima T, Katsuki NE, Anzai K, Yamashita SI. Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study. Int J Gen Med 2020; 13:547-557. [PMID: 32922065 PMCID: PMC7457800 DOI: 10.2147/ijgm.s264497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Our hospital’s department of general medicine is often involved in the diagnosis and treatment of diseases that are considered by other hospitals or other departments in our hospital to be difficult to diagnose correctly. Objective The aim of this study was to clarify how patients with infective endocarditis (IE) being admitted to our hospital’s department of general medicine were examined and treated and to elucidate their prognosis compared with patients admitted to other departments. Materials and Methods Inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were divided into 2 groups: those admitted to the general medicine department (the GM group) and those admitted to other departments (the non-GM group). Results Seventy-four patients were included; 17 (23%) were admitted to the general medicine department. In the GM group, the percentage of patients diagnosed with definite or suspected IE was lower (0% vs 32%, p=0.008), as was the rate of patients with echocardiographic findings that fulfilled the major modified Duke’s criteria (71% vs 98%, p≤0.001), preadmission. The GM group had higher percentages of patients with back or joint pain (41% vs 9%, p=0.001) and complications, including pyogenic spondylitis (35% vs 2%, p≤0.001), deep-seated abscesses (24% vs 5%, p=0.024), pyogenic arthritis (18% vs 0%, p=0.001), and glomerulonephritis (77% vs 37%, p=0.004) than did the non-GM group. Mortality within 30 days of admission to our hospital (12% vs 14%, p=0.753) and overall in-hospital mortality (12% vs 18%, p=0.570) did not significantly differ. Conclusion The general medicine department could have accurately diagnosed IE, given appropriate treatments, and obtained similar prognoses to those of IE patients treated by other departments, including cardiology and cardiovascular surgery, even in patients for whom diagnosing IE was more difficult or who had less typical echocardiographic findings preadmission.
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Affiliation(s)
- Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Keizo Anzai
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
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Brunet A, Julien G, Cros A, Beaudoux O, Hittinger-Roux A, Bani-Sadr F, Servettaz A, N'Guyen Y. Vasculitides and glomerulonephritis associated with Staphylocococcus aureus infective endocarditis: cases reports and mini-review of the literature. Ann Med 2020; 52:265-274. [PMID: 32588668 PMCID: PMC7877925 DOI: 10.1080/07853890.2020.1778778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We reported two cases of Staphylococcus aureus Infective Endocarditis associated with vasculitides and glomerulonephritis respectively, before conducting an online search of previously published similar cases reports. Twenty five references were selected: 15 cases of glomerulonephritis; 2 cases of vasculitis and 8 cases involving both glomerulonephritis and vasculitis. Vasculitides and glomerulonephritis associated with Staphylococcus aureus definite Infective Endocarditis have been reported since 1976. All cases except one described clinical symptoms occurring before or during initial antibiotics treatment. Except kidney, organs that were more frequently affected by vasculitis process were skin, gastrointestinal tract and peripheral nerve and the vessels involved were small to medium size vessels. When antineutrophil cytoplasmic antibodies were evidenced (6 out of the 25 cases (24%)), kidney was the most frequently affected organ. The most commonly observed pattern in Kidney biopsy was membranoproliferative glomerulonephritis with endocapillary proliferation sometimes associated with extra capillary crescents, whether or not antineutrophil cytoplasmic antibodies were evidenced. Right-sided Infective Endocarditis (especially in intravenous drug users) were overrepresented (14 of the 25 cases (56.0%)) in this review. Besides antibiotics, corticosteroids were the most frequently prescribed immunosuppressive treatment both for vasculitides or glomerulonephritis. KEY MESSAGES Vasculitides and glomerulonephritis associated with Staphylococcus aureus definite Infective Endocarditis have been reported since 1976. Except kidney, organs that were more frequently affected (by small to medium size vessel vasculitis) were skin, gastrointestinal tract and peripheral nerve. The most commonly observed pattern in Kidney biopsy was membranoproliferative glomerulonephritis with endocapillary proliferation and right-sided Infective Endocarditis (especially in intravenous drug users) were overrepresented in this review.
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Affiliation(s)
- Aurélie Brunet
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Gautier Julien
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Amandine Cros
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Olivia Beaudoux
- Laboratoire d'Anatomie pathologique, Hôpital Robert Debré, Reims, France
| | | | | | - Amélie Servettaz
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Yohan N'Guyen
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
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Risk factors and outcomes of early acute kidney injury in infective endocarditis: A retrospective cohort study. Int J Infect Dis 2020; 99:421-427. [PMID: 32795604 DOI: 10.1016/j.ijid.2020.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The incidence of acute kidney injury (AKI) in infective endocarditis (IE), its risk factors and consequences on patient and renal survival remain debated. METHODS Patients hospitalized for a first episode of IE (possible or definite according to modified Duke criteria) between 2013 and 2016 were included. The primary endpoint was to determine risk factors for early AKI (E-AKI) during the first week of management of IE. RESULTS A total of 276 patients were included: 220 (79.7%) had definite IE and 56 (20.3%) had possible IE. E-AKI occurred in 150 patients (53%). IE due to Staphylococcus aureus (OR 3.41; 95% CI 1.83-6.39; p<0.01), history of diabetes (OR 2.34; 95% CI 1.25-4.37; p<0.01), peripheral arterial disease (OR 2.59; 95% CI 1.07-6.23; p<0.05), immunological manifestations (OR 3.11; 95% CI 1.31-7.39; p=0.01), and use of norepinephrine (OR 3.44; 95% CI 1.72-7.02; p<0.01) were associated with E-AKI. In subgroup analysis, infectious disease consultation was associated with a lower risk of AKI at day 7 (OR 0.41; 95% CI 0.16-0.88; p=0.04). E-AKI was associated with 1-year mortality (OR 1.65; 95% CI 1.03-2.64; p=0.04) and chronic kidney disease progression (OR 2.23; 95% CI 1.30-3.82; p<0.01). CONCLUSIONS E-AKI is common in IE and often associated with non-modifiable variables. Multidisciplinary management should be mandatory, and awareness of AKI diagnosis and etiological explorations should be raised.
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Shi XD, Li WY, Shao X, Qu LM, Jiang ZY. Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review. Medicine (Baltimore) 2020; 99:e21358. [PMID: 32702934 PMCID: PMC7373528 DOI: 10.1097/md.0000000000021358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE In the course of endocarditis, the development of antineutrophil cytoplasmic antibody (ANCA)-mediated disease introduces the dilemma of determining the best treatment approach for immune conditions, whether immunosuppressant therapy should be added to antibiotic treatment has remained controversial. PATIENT CONCERNS A 33-year-old man presented with progressive fever lasting for 7 months, and swelling, pain, and purpura in the arms and legs. The patient showed multiple autoantibodies including cytoplasmic ANCA, antiproteinase 3, rheumatoid factor, and anti-beta 2 glycoprotein I. Blood culture was positive for viridans streptococcus, and renal biopsy revealed glomerulonephritis and interstitial nephritis. DIAGNOSIS Endocarditis caused by viridans streptococci, ANCA-associated vasculitis, and congenital ventricular septal defect. INTERVENTIONS In addition to effective antibiotics, he also received twice intravenous corticosteroids and intravenous immunoglobulin therapy, and a low dose of cyclophosphamide. At last, the patient received congenital ventricular septal defect repair and debridement. OUTCOMES The abnormal clinical manifestations, including renal failure and loss of strength, recovered rapidly with corticosteroid therapy in addition to antibiotic treatment. After 6 months without any medications, he remained asymptomatic and was able to live normally. LESSONS In this case with endocarditis and ANCA-associated vasculitis, we highlighted the importance of biopsy and immunosuppressive therapy. Histopathologic examination is required for diagnosis and treatment in such case. Identifying patients who have endocarditis and ANCA positivity with vasculitis pathologic features will require corticosteroid/immunosuppressives in addition to the antibiotics therapy.
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Affiliation(s)
| | - Wan-yu Li
- Hepatology, First Hospital of Jilin University
| | - Xue Shao
- Hepatopancreatobiliary Medicine, Second Hospital of Jilin University
| | - Li-mei Qu
- Pathology Department, First Hospital of Jilin University, Changchun, China
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21
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Zhang Q, Shi B, Zeng H. Antineutrophil cytoplasmic antibodies (ANCA)-positive patient with infective endocarditis and chronic hepatitis B virus: a case report and review of the literature. J Med Case Rep 2020; 14:90. [PMID: 32624005 PMCID: PMC7336675 DOI: 10.1186/s13256-020-02373-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/17/2020] [Indexed: 01/05/2023] Open
Abstract
Background Antineutrophil cytoplasmic antibodies comprise a family of autoantibodies that are often used as biomarkers for certain forms of small-vessel vasculitis; however, chronic infections tend to induce the production of antineutrophil cytoplasmic antibodies. Infective endocarditis and hepatitis B virus infection have been reported to exhibit antineutrophil cytoplasmic antibody positivity and to mimic antineutrophil cytoplasmic antibody–associated vasculitis, which may lead to misdiagnosis and inappropriate treatment. Case presentation We report a case of a 46-year-old Han Chinese man with untreated chronic hepatitis B virus infection who featured proteinase-3 antineutrophil cytoplasmic antibody positivity while hospitalized with infective endocarditis. Cardiac ultrasound echocardiography disclosed mitral and aortic regurgitation with vegetation. On the 15th hospital day, the patient underwent mitral and aortic valve replacement and was then treated with antibiotics for more than 1 month. On the 57th hospital day, the patient was discharged. His urinary abnormalities and renal function were gradually recovering. Four months after being discharged, his proteinase-3 antineutrophil cytoplasmic antibody levels had returned to the normal range. Conclusions The findings in this study update and expand current understanding of antineutrophil cytoplasmic antibody positivity in patients with both infective endocarditis and hepatitis B virus. Treatment (including surgery, antibiotics, corticosteroids and/or cyclophosphamide, antiviral agents, and even plasma exchange) is challenging when several diseases are combined. Renal biopsy is suggested if the patient’s condition allows. Antineutrophil cytoplasmic antibody testing should be repeated after therapy, because some cases might require more aggressive treatment.
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Affiliation(s)
- Qian Zhang
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Baoxian Shi
- Department of Chemistry and Environmental Engineering, Wuhan Polytechnic University, Wuhan, Hubei, People's Republic of China
| | - Hongbing Zeng
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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Hickey NA, Shalamanova L, Whitehead KA, Dempsey-Hibbert N, van der Gast C, Taylor RL. Exploring the putative interactions between chronic kidney disease and chronic periodontitis. Crit Rev Microbiol 2020; 46:61-77. [PMID: 32046541 DOI: 10.1080/1040841x.2020.1724872] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) and chronic periodontitis (CP) are both common diseases, which are found disproportionately comorbid with each other and have been reported to have a detrimental effect on the progression of each respective disease. They have an overlap in risk factors and both are a source of systemic inflammation along with a wide selection of immunological and non-specific effects that can affect the body over the lifespan of the conditions. Previous studies have investigated the directionality of the relationship between these two diseases; however, there is a lack of literature that has examined how these diseases may be interacting at the localized and systemic level. This review discusses how oral microorganisms have the ability to translocate and have distal effects and provides evidence for microbial involvement in a systemic disease. Furthermore, it summarizes the reported local and systemic effects of CKD and CP and discusses how the interaction of these effects may be responsible for directionality associations reported.
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Affiliation(s)
- Niall A Hickey
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Liliana Shalamanova
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Kathryn A Whitehead
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Nina Dempsey-Hibbert
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Christopher van der Gast
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Rebecca L Taylor
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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23
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Elashery AR, Stratidis J, Patel AD. Double-Valve Heart Disease and Glomerulonephritis Consequent to Abiotrophia defectiva Endocarditis. Tex Heart Inst J 2020; 47:35-37. [PMID: 32148451 DOI: 10.14503/thij-17-6575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abiotrophia defectiva, a nutritionally deficient streptococcus, is a rare cause of infective endocarditis. It has been associated with hemophagocytic syndrome. We present the first case of A. defectiva infective endocarditis that led to antineutrophil cytoplasmic antibody-associated glomerulonephritis. The patient was a 55-year-old man whose endocarditis affected the mitral and aortic valves. His course was complicated by atrial fibrillation, stroke, and glomerulonephritis. He was successfully treated with antibiotics and dual valve replacement.
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Yamashita S, Tokushima M, Nakashima T, E Katsuki N, Tago M, Yamashita SI. Clinical Status Quo of Infective Endocarditis in a University Hospital in Japan: A Single-hospital-based Retrospective Cohort Study. Intern Med 2020; 59:1497-1507. [PMID: 32536676 PMCID: PMC7364241 DOI: 10.2169/internalmedicine.4159-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective No research on infective endocarditis (IE) concerning populations of more than 40 patients from all departments of the hospitals they may have visited in Japan has been conducted since 2000. The present study clarified the status quo of IE in a university hospital in Japan. Methods Data of inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were retrospectively analyzed. Patients Records of inpatients with diagnosed IE admitted to any department were scrutinized; those with "definite IE" according to the modified Duke's criteria comprised the study cohort. Results The study cohort was 74 patients with a median age 66.5 years old. Symptoms within 2 months before the first visit to our hospital included a fever (73.0%), general malaise (33.8%), disturbance of consciousness (24.3%), and dyspnea (24.3%). High-frequency causative microorganisms were Staphylococcus aureus (28.4%), followed by Streptococcus viridans (18.9%) and Enterococcus spp. (6.8%). The most frequently involved valves were the mitral valve (48.6%), followed by the aortic valve (25.7%) and multiple valves (14.9%). Patients without cardiac murmurs accounted for 37.8%, and those without or with only mild valvular disease accounted for 32.4%. The incidence of complications was 93.2%, and high-frequency complications were central nervous system disorder (60.8%), followed by glomerulonephritis (45.9%) and extracranial embolism (36.5%). Conclusion The incidences of IE without cardiac murmurs and IE without or with only minor valvular disease were higher than those values previously reported in 2000 in Japan. When IE is suspected clinically, clinicians must check thoroughly for common complications, even in patients without cardiac murmurs or valvular disease.
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Affiliation(s)
- Shun Yamashita
- Department of General Medicine, Saga University Hospital, Japan
| | | | | | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Japan
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Acute Kidney Injury After Nephrotoxic Antibiotic Therapy in Patients with Infective Endocarditis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.87617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. Nat Rev Nephrol 2019; 16:32-50. [PMID: 31399725 DOI: 10.1038/s41581-019-0178-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/31/2022]
Abstract
For over a century, acute 'post-streptococcal glomerulonephritis' (APSGN) was the prototypical form of bacterial infection-associated glomerulonephritis, typically occurring after resolution of infection and a distinct infection-free latent period. Other less common forms of infection-associated glomerulonephritides resulted from persistent bacteraemia in association with subacute bacterial endocarditis and shunt nephritis. However, a major paradigm shift in the epidemiology and bacteriology of infection-associated glomerulonephritides has occurred over the past few decades. The incidence of APSGN has sharply declined in the Western world, whereas the number of Staphylococcus infection-associated glomerulonephritis (SAGN) cases increased owing to a surge in drug-resistant Staphylococcus aureus infections, both in the hospital and community settings. These Staphylococcus infections range from superficial skin infections to deep-seated invasive infections such as endocarditis, which is on the rise among young adults owing to the ongoing intravenous drug use epidemic. SAGN is markedly different from APSGN in terms of its demographic profile, temporal association with active infection and disease outcomes. The diagnosis and management of SAGN is challenging because of the lack of unique histological features, the frequently occult nature of the underlying infection and the older age and co-morbidities in the affected patients. The emergence of multi-drug-resistant bacterial strains further complicates patient treatment.
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Incidence and Cost of Acute Kidney Injury in Hospitalized Patients with Infective Endocarditis. J Clin Med 2019; 8:jcm8070927. [PMID: 31252690 PMCID: PMC6678671 DOI: 10.3390/jcm8070927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI) is a frequent complication of hospitalized patients with infective endocarditis (IE). Further, AKI in the setting of IE is associated with high morbidity and mortality. We aimed to examine the incidence, clinical parameters, and hospital costs associated with AKI in hospitalized patients with IE in an endemic area with an increasing prevalence of opioid use. This retrospective cohort study included 269 patients admitted to a major referral center in Kentucky with a primary diagnosis of IE from January 2013 to December 2015. Of these, 178 (66.2%) patients had AKI by Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria: 74 (41.6%) had AKI stage 1 and 104 (58.4%) had AKI stage ≥2. In multivariable analysis, higher comorbidity scores and the need for diuretics were independently associated with AKI, while the involvement of the tricuspid valve and the need for vasopressor/inotrope support were independently associated with severe AKI (stage ≥2). The median total direct cost of hospitalization was progressively higher according to each stage of AKI ($17,069 for no AKI; $37,111 for AKI stage 1; and $61,357 for AKI stage ≥2; p < 0.001). In conclusion, two-thirds of patients admitted to the hospital due to IE had incident AKI. The occurrence of AKI significantly increased healthcare costs. The higher level of comorbidity, the affection of the tricuspid valve, and the need for diuretics and/or vasoactive drugs were associated with severe AKI in this susceptible population.
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28
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Gagneux-Brunon A, Pouvaret A, Maillard N, Berthelot P, Lutz MF, Cazorla C, Tulane C, Fuzellier JF, Verhoeven PO, Frésard A, Duval X, Lucht F, Botelho-Nevers E. Acute kidney injury in infective endocarditis: A retrospective analysis. Med Mal Infect 2019; 49:527-533. [PMID: 30955847 DOI: 10.1016/j.medmal.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/26/2018] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria. METHODS Using the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015. RESULTS Seventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n=29, 37.7% vs. n=4, 1.4%, P<0.0005), cardiac failure (n=29, 36.7% vs. n=1, 2.9%, P<0.0005), diabetes mellitus (n=14, 18.2% vs. n=1, 0.9%, P=0.034), and prosthetic valve IEs (n=24, 31.2% vs. n=4, 11.4%). No differences were observed for gentamicin exposure (n=57, 64% vs. n=32, 86.5%, P=0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92-17.9), 4.37 (95% CI 4.37-465.7), and 1.084 (1.084-16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4±22.1 days vs. 39.6±12.6, P<0.005). CONCLUSION AKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.
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Affiliation(s)
- A Gagneux-Brunon
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France.
| | - A Pouvaret
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - N Maillard
- EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Department of Nephrology, Dialysis, Transplantation and Hypertension, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - P Berthelot
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Laboratory of Microbiology and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Infection Control Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - M F Lutz
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - C Cazorla
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - C Tulane
- Department of Cardiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - J F Fuzellier
- Department of Cardiac Surgery, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - P O Verhoeven
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Laboratory of Microbiology and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - A Frésard
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - X Duval
- Inserm 1425, Inserm U1137, Centre d'Investigation Clinique, Université Paris-Diderot, Hôpital Bichat, AP-HP, 75018 Paris, France
| | - F Lucht
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - E Botelho-Nevers
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
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Malhotra K, Yerram P. Plasmapheresis and corticosteroids in infective endocarditis-related crescentic glomerulonephritis. BMJ Case Rep 2019; 12:12/3/e227672. [PMID: 30872338 DOI: 10.1136/bcr-2018-227672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infective endocarditis (IE)-related glomerulonephritis (GN) typically resolves with the treatment of IE. A 59-year-old woman with a baseline creatinine of 0.7 mg/dL presented with rash on her legs, night sweats and weight loss for 3 weeks. Further evaluation revealed IE. Her blood cultures grew gamma-haemolytic streptococcus, which subsequently cleared on appropriate antibiotic therapy. Her creatinine, however, progressively worsened requiring haemodialysis. Kidney biopsy showed immune complex-mediated necrotising and crescentic GN. She was started on plasmapheresis (PE) and high-dose steroids with rapid taper, with subsequent improvement in her creatinine to 0.8 mg/dL. She subsequently had aortic valve replacement and ventricular septal defect closure. She did not improve as expected with antibiotic therapy but turned around dramatically with steroids and PE. Our case supports the possible beneficial role of PE and steroids in IE-related crescentic GN that worsens despite appropriate antibiotic therapy, although the risks of immunosuppression and aggravating endocarditis need to be considered.
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Affiliation(s)
- Kunal Malhotra
- Division of Nephrology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Preethi Yerram
- Division of Nephrology, University of Missouri School of Medicine, Columbia, Missouri, USA
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Plasmapheresis for treatment of immune complex-mediated glomerulonephritis in infective endocarditis: a case report and literature review. Clin Nephrol Case Stud 2017; 5:26-31. [PMID: 29043144 PMCID: PMC5438014 DOI: 10.5414/cncs109082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 57-year-old man who presented with subacute bacterial endocarditis secondary to Streptococcus mutans complicated by biopsy-proven immune complex-mediated glomerulonephritis (ICGN). Despite initial treatment with antibiotics and a short course of corticosteroids, the kidney function further deteriorated, and plasmapheresis was introduced as third-line therapy to remove circulating immune complexes. Following 7 treatment sessions, the patient recovered kidney function. We discuss the potential merit of plasmapheresis for patients with subacute bacterial endocarditis who develop ICGN.
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Successful treatment of acute renal failure secondary to complicated infective endocarditis by peritoneal dialysis: a case report. BMC Res Notes 2017; 10:463. [PMID: 28882165 PMCID: PMC5590162 DOI: 10.1186/s13104-017-2773-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis is one of the most common infections among intravenous drug addicts. Its complications can affect many systems, and these can include acute renal failure. There is a scarcity of cases in the literature related to acute renal failure secondary to infective endocarditis treated with peritoneal dialysis. In this paper, the case of a 48-year-old Saudi male is reported, who presented with features suggestive of infective endocarditis and who developed acute kidney injury that was treated successfully with high tidal volume automated peritoneal dialysis. To our knowledge, this is the second report of such an association in the literature. CASE PRESENTATION A 48-year-old Saudi gentleman diagnosed to have a glucose-6-phosphate dehydrogenase deficiency and hepatitis C infection for the last 9 years, presented to the emergency department with a history of fever of 2 days' duration. On examination: his temperature = 41 °C, there was clubbing of the fingers bilaterally and a pansystolic murmur in the left parasternal area. The results of the blood cultures and echocardiogram were supportive of the diagnosis of infective endocarditis, and the patient subsequently developed acute kidney injury, and his creatinine reached 5.2 mg/dl, a level for which dialysis is essential for the patient to survive. CONCLUSION High tidal volume automated peritoneal dialysis is highly effective as a renal replacement therapy in acute renal failure secondary to infective endocarditis if no contraindication is present.
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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. [PMID: 27077635 DOI: 10.1080/20469047.2015.1135562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Renal involvement in infective endocarditis (IE) may manifest with different clinical patterns, including diffuse proliferative glomerulonephritis and crescentic glomerulonephritis, which may lead to haematuria and/or proteinuria. However, severe acute kidney injury (AKI) in such cases is extremely uncommon and is reported mostly in adults. Two children with rheumatic heart disease and a peri-membranous ventricular septal defect, respectively, who developed haematuria, proteinuria and severe AKI in association with IE are reported. The first case had diffuse proliferative glomerulonephritis with 10% cellular crescents, and made a complete renal recovery with antibiotics and intravenous methylprednisolone followed by oral prednisolone. However, the second case had severe crescentic glomerulonephritis which led to residual renal injury despite intravenous methylprednisolone and cyclophosphamide in combination with antibiotics. The cases illustrate that crescentic glomerulonephritis or severe diffuse proliferative glomerulonephritis should be considered as possible complications in children presenting with haematuria, proteinuria and severe AKI. Renal biopsy along with antibiotic therapy and prompt immunosuppressive therapy should be considered for the management of this potentially life-threatening condition.
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Affiliation(s)
| | | | | | | | - Nachiappa Ganesh Rajesh
- c Pathology , Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry , India
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ANCA-associated pauci-immune glomerulonephritis in a patient with bacterial endocarditis: a challenging clinical dilemma. Clin Nephrol Case Stud 2017; 5:32-37. [PMID: 29043145 PMCID: PMC5438016 DOI: 10.5414/cncs109076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/03/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose: We report the case of a 59-year-old man with chronic hepatitis B and C infection presenting with acute kidney injury and enterococcus faecalis-infective endocarditis (IE). An elevated proteinase-3 (PR3)-ANCA and pauci-immune glomerulonephritis (GN) on renal biopsy were discovered, corresponding to ANCA-mediated GN. We conducted a literature review to assess the role of ANCA in IE and treatment implications. Methods: On systematic review of the literature, we found five previous cases whereby IE caused by streptococcus and bartonella species were related to ANCA vasculitis-associated GN. Results: Most reports of IE-related GN are mediated by immune complex deposition and resolve following microbial clearance. Of the 5 cases of ANCA GN in the setting of IE, all had markedly elevated levels of PR3-ANCA with either a subacute or chronic course of infection. Patients were treated with a combination of steroids and cyclophosphamide (2/5), steroids and antibiotics alone (1/5), or with valvular replacement (2/5). Renal function was recovered in 4/5 patients. Conclusion: Infection is a major etiologic player in the formation of ANCA; however, the role of PR3-ANCA in IE remains unclear. Kidney biopsy is essential in differentiating IE-related GN due to infection and immune complex deposition versus ANCA-associated vasculitis. A paucity of reports on the development of GN in IE-associated ANCA vasculitis exists, highlighting the rarity of our case and lack of clear therapeutic strategies in a patient with active infection requiring immunosuppression. In this case, the patient’s chronic hepatitis B and C coinfection presented a unique challenge.
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Goenaga Sánchez MÁ, Kortajarena Urkola X, Bouza Santiago E, Muñoz García P, Verde Moreno E, Fariñas Álvarez MC, Teira Cobo R, Pericás Pulido JM, de Alarcón González A, Sousa Regueiro D, Ruiz Morales J, Rodríguez-Álvarez RJ, Antorrena Miranda I, Iribarren Loyarte JA. Aetiology of renal failure in patients with infective endocarditis. The role of antibiotics. Med Clin (Barc) 2017; 149:331-338. [PMID: 28431897 DOI: 10.1016/j.medcli.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/23/2017] [Accepted: 03/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The possible renal toxicity of certain antibiotics (AB) is well known. The objective of our work is to know the possible effect of AB treatments in the development of renal failure (RF) in patients with infective endocarditis (IE). MATERIAL AND METHOD Collection from a national multi-centre registry of collection on renal function, both prior and its impairment, if any, during the treatment of IE and in relation to possible causative factors, including the use of AB. RESULTS Between 2008 and 2012, 1,853 episodes of IE reported from 26 Spanish centres were analysed. Of these, 21.6% had prior RF. They developed new RF or impairment of renal function in 38.7% of the cases. In patients with prior RF, impairment was more frequent (64 vs. 31.7%, P<.001). Overall, patients with RF were older (70.6 vs. 67 years, P<.01), had more comorbidities (Charlson index 5 vs. 4, P<.01), and IE by Staphylococcus aureus (32.1 vs. 16.5%, P<.01). Potentially nephrotoxic AB use was only associated with RF in patients without prior RF (aminoglycosides: OR=1.47 [95% CI 1.096-1.988], P=.010; aminoglycosides with vancomycin: OR=1.49 [95% CI 1.069-2.09], P=.019). CONCLUSIONS In patients without prior RF, the use of nephrotoxic AB is associated with impairment of renal function. In patients with RF prior to the IE episode, impairment of renal function was more frequent but appears to be more related to the severity of infection.
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Affiliation(s)
| | - Xabier Kortajarena Urkola
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Emilio Bouza Santiago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Patricia Muñoz García
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Eduardo Verde Moreno
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Carmen Fariñas Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Ramón Teira Cobo
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Santander, España
| | - Juan Manuel Pericás Pulido
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Arístides de Alarcón González
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, España
| | - Dolores Sousa Regueiro
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Josefa Ruiz Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
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Ritchie BM, Hirning BA, Stevens CA, Cohen SA, DeGrado JR. Risk factors for acute kidney injury associated with the treatment of bacterial endocarditis at a tertiary academic medical center. J Chemother 2017; 29:292-298. [PMID: 28245728 DOI: 10.1080/1120009x.2017.1296916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of endocarditis. OBJECTIVE To determine risk factors for the development of AKI in patients treated for endocarditis. METHODS This single centre, retrospective univariate and multivariate analysis to determine risk factors for the development of AKI included patients diagnosed with endocarditis between January 2009 and October 2013. RESULTS Of 211 included patients, a total of 84 (39.8%) patients developed AKI. We identified multiple independent variables associated with the development of AKI, including: age ≥ 65 years, presence of hardware, chronic kidney disease, AKI on admission, infection with Staphylococcus spp, receipt of nafcillin or oxacillin or aminoglycoside and nafcillin or oxacillin or aminoglycoside and vancomycin, vancomycin trough level ≥ 20.0 mcg/ml, aminoglycoside total daily dose reduction, duration of vancomycin exceeding three days, receipt of loop diuretic or more than three concomitant nephrotoxins and duration of loop diuretic or non-steroidal anti-inflammatory drug therapy exceeding seven days. CONCLUSIONS In patients treated for endocarditis, multiple risk factors for AKI were identified. Prospective studies are needed to evaluate these variables for causation of AKI in patients treated for endocarditis.
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Affiliation(s)
| | - Beth A Hirning
- b Department of Pharmacy Services , Brigham and Women's Hospital , Boston , MA , USA
| | - Craig A Stevens
- b Department of Pharmacy Services , Brigham and Women's Hospital , Boston , MA , USA
| | - Steven A Cohen
- c Department of Kinesiology, Health Studies Program , University of Rhode Island , Kingston , RI , USA
| | - Jeremy R DeGrado
- b Department of Pharmacy Services , Brigham and Women's Hospital , Boston , MA , USA
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Lamba A, Kapp M, Paueksakon P, Parekh PJ. A wolf in another wolf's clothing. IDCases 2017; 8:22-26. [PMID: 28289605 PMCID: PMC5344216 DOI: 10.1016/j.idcr.2017.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/25/2022] Open
Abstract
This case of infective endocarditis masquerading as mixed cryoglobulinemia in a man with a history of intravenous drug use (IVDU) and hepatitis C virus (HCV) highlights the importance of maintaining a broad differential and continually re-evaluating the working diagnosis as new information presents itself. The patient presented to an outside hospital and was treated for presumptive mixed cryoglobulinemia with corticosteroid therapy. When the patient did not improve, he was transferred to a tertiary care center for possible Rituximab and/or plasmapheresis. Further investigation revealed Enterococcus bacteremia with subsequent workup consistent with infective endocarditis (IE). This case highlights a diagnostic dilemma and demonstrates the importance of a thorough evaluation as it pertains to overlapping features of IE and mixed cryoglobulinemia.
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Affiliation(s)
- Amrit Lamba
- Tulane University, Department of Internal Medicine, United States
| | - Meghan Kapp
- Vanderbilt University, Department of Pathology, United States
| | | | - Parth J. Parekh
- Tulane University, Department of Internal Medicine, Division of Gastroenterology and Hepatology, United States
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Androsova TV, Kozlovskaya LV, Taranova MV, Strizhakov LA, Gulyaev SV, Russkikh AV. Difficulties in the differential diagnosis of kidney injury in a patient with infective endocarditis associated with antineutrophil cytoplasmic antibodies. TERAPEVT ARKH 2017; 89:84-88. [DOI: 10.17116/terarkh201789684-88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Raybould JE, Raybould AL, Morales MK, Zaheer M, Lipkowitz MS, Timpone JG, Kumar PN. Bartonella Endocarditis and Pauci-Immune Glomerulonephritis: A Case Report and Review of the Literature. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016; 24:254-260. [PMID: 27885316 PMCID: PMC5098464 DOI: 10.1097/ipc.0000000000000384] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Among culture-negative endocarditis in the United States, Bartonella species are the most common cause, with Bartonella henselae and Bartonella quintana comprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of all Bartonella patients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis-associated glomerulonephritis, it is rarely reported in Bartonella endocarditis. Anti-neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported with Bartonella species. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate between Bartonella endocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positive Bartonella endocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone.
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Affiliation(s)
- Jillian E Raybould
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Alison L Raybould
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Megan K Morales
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Misbah Zaheer
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Michael S Lipkowitz
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Joseph G Timpone
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Princy N Kumar
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
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Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:3585860. [PMID: 27366166 PMCID: PMC4904576 DOI: 10.1155/2016/3585860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
While antineutrophil cytoplasmic antibody (ANCA) is often used as a diagnostic marker for certain vasculitides, ANCA induction in the setting of infection is much less common. In the case of infective endocarditis, patients may present with multisystem disturbances resembling an autoimmune process, cases that may be rendered even trickier to diagnose in the face of a positive ANCA. Though not always straightforward, distinguishing an infective from an inflammatory process is pivotal in order to guide appropriate therapy. We describe an encounter with a 43-year-old male with chronically untreated hepatitis C virus infection who featured ANCA positivity while hospitalized with acute bacterial endocarditis. His case serves as a reminder of two of the few infections known to uncommonly generate ANCA positivity. We also summarize previously reported cases of ANCA positivity in the context of endocarditis and hepatitis C infections.
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Abstract
The kidney is involved in a wide range of bacterial, viral, fungal, and parasitic diseases. In most systemic infections, renal involvement is a minor component of the illness, but in some, renal failure may be the presenting feature and the major problem in management. Although individual infectious processes may have a predilection to involve the renal vasculature, glomeruli, interstitium, or collecting systems, a purely anatomic approach to the classification of infectious diseases affecting the kidney is rarely helpful because most infections may involve several different aspects of renal function. In this chapter, a microbiological classification of the organisms affecting the kidney is adopted. Although they are important causes of renal dysfunction in infectious diseases, urinary tract infections and hemolytic uremic syndrome (HUS) are not discussed in detail because they are considered separately in chapters XX and XX, respectively.
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Affiliation(s)
- Ellis D. Avner
- Department of Pediatrics, Medical College of Wisconsin, Children’s Research Institute, Children’s Hospital, Health System of Wisconsin, Milwaukee, Wisconsin USA
| | - William E. Harmon
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Patrick Niaudet
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Université Paris-Descartes, Paris, France
| | | | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, Ohio USA
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Necrotizing ANCA-Positive Glomerulonephritis Secondary to Culture-Negative Endocarditis. Case Rep Nephrol 2015; 2015:649763. [PMID: 26819786 PMCID: PMC4706874 DOI: 10.1155/2015/649763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022] Open
Abstract
Infective endocarditis (IE) and small-vessel vasculitis may have similar clinical features, including glomerulonephritis. Furthermore the association between IE and ANCA positivity is well documented, making differential diagnosis between IE- and ANCA-associated vasculitis particularly difficult, especially in case of culture-negative IE. We report on one patient with glomerulonephritis secondary to culture-negative IE caused by Bartonella henselae which illustrates this diagnostic difficulty.
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Ihlemann N, Møller-Hansen M, Salado-Rasmussen K, Videbæk R, Moser C, Iversen K, Bundgaard H. CIED infection with either pocket or systemic infection presentation--complete device removal and long-term antibiotic treatment; long-term outcome. SCAND CARDIOVASC J 2015; 50:52-7. [PMID: 26485501 DOI: 10.3109/14017431.2015.1091089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Cardiovascular implantable electronic device (CIED) infections are increasing in numbers. The objective was to review the clinical presentation and outcome in patients affected with CIED infections with either local pocket or systemic presentation. DESIGN All device removals due to CIED infection during the period from 2005 to 2012 were retrospectively reviewed. CIED infections were categorized as systemic or pocket infections. Treatment included complete removal of the device, followed by antibiotic treatment of six weeks. RESULTS Seventy-one device removals due to infection (32 systemic and 39 pocket infections) were recorded during the study period. Median follow-up time was 26 (IQR 9-41) months, 30 day and 12 month mortality were 4% and 14%, respectively. There was no long-term difference in mortality between patients with pocket vs. systemic infection (p = 0.48). During follow-up no relapses and two cases of new infections were noted (2.8%). CONCLUSIONS CIED infection with systemic or pocket infection was difficult to distinguish in clinical presentation and outcome. Complete device removal and antibiotic treatment of long duration was safe and without relapses.
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Affiliation(s)
- Nikolaj Ihlemann
- a Department of Cardiology , The Heart Centre, University Hospital of Copenhagen, Rigshospitalet , Denmark
| | - Michael Møller-Hansen
- a Department of Cardiology , The Heart Centre, University Hospital of Copenhagen, Rigshospitalet , Denmark
| | | | - Regitze Videbæk
- a Department of Cardiology , The Heart Centre, University Hospital of Copenhagen, Rigshospitalet , Denmark
| | - Claus Moser
- c Department of Clinical Microbiology , University Hospital of Copenhagen, Rigshospitalet , Denmark , and
| | - Kasper Iversen
- d Department of Cardiology , Herlev Hospital, Copenhagen , Denmark
| | - Henning Bundgaard
- a Department of Cardiology , The Heart Centre, University Hospital of Copenhagen, Rigshospitalet , Denmark
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3073] [Impact Index Per Article: 341.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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Dong Y, Huang J, Li G, Li L, Li W, Li X, Liu X, Liu Z, Lu Y, Ma A, Sun H, Wang H, Wen X, Xu D, Yang J, Zhang J, Zhao H, Zhou J, Zhu L, Committee Members:, Bai L, Cao K, Chen M, Chen M, Dai G, Ding W, Dong W, Fang Q, Fang W, Fu X, Gao W, Gao R, Ge J, Ge Z, Gu F, Guo Y, Han H, Hu D, Huang W, Huang L, Huang C, Huang D, Huo Y, Jin W, Ke Y, Lei H, Li X, Li Y, Li D, Li G, Li X, Li Z, Liang Y, Liao Y, Liu G, Ma A, Ma C, Ma D, Ma Y, Shen L, Sun J, Sun C, Sun Y, Tang Q, Wan Z, Wang H, Wang J, Wang S, Wang D, Wang G, Wang J, Wu Y, Wu P, Wu S, Wu X, Wu Z, Yang J, Yang T, Yang X, Yang Y, Yang Z, Ye P, Yu B, Yuan F, Zhang S, Zhang Y, Zhang R, Zhang Y, Zhang Y, Zhao S, Zhou X. Guidelines for the prevention, diagnosis, and treatment of infective endocarditis in adults: The Task Force for the Prevention, Diagnosis, and Treatment of Infective Endocarditis in Adults of Chinese Society of Cardiology of Chinese Medical Association, and of the Editorial Board of Chinese Journal of Cardiology. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Update on endocarditis-associated glomerulonephritis. Kidney Int 2015; 87:1241-9. [PMID: 25607109 PMCID: PMC4455140 DOI: 10.1038/ki.2014.424] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/24/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
Glomerulonephritis (GN) due to infective endocarditis (IE) is well documented, but most available data are based on old autopsy series. To update information, we now present the largest biopsy-based clinicopathologic series on IE-associated GN. The study group included 49 patients (male-to-female ratio of 3.5:1) with a mean age of 48 years. The most common presenting feature was acute kidney injury. Over half of the patients had no known prior cardiac abnormality. However, the most common comorbidities were cardiac valve disease (30%), intravenous drug use (29%), hepatitis C (20%), and diabetes (18%). The cardiac valve infected was tricuspid in 43%, mitral in 33%, and aortic in 29% of patients. The two most common infective bacteria were Staphylococcus (53%) and Streptococcus (23%). Hypocomplementemia was found in 56% of patients tested and ANCA antibody in 28%. The most common biopsy finding was necrotizing and crescentic GN (53%), followed by endocapillary proliferative GN (37%). C3 deposition was prominent in all cases, whereas IgG deposition was seen in <30% of cases. Most patients had immune deposits detectable by electron microscopy. Thus, IE-associated GN most commonly presents with AKI and complicates staphylococcal tricuspid valve infection. Contrary to infection-associated glomerulonephritis in general, the most common pattern of glomerular injury in IE-associated glomerulonephritis was necrotizing and crescentic glomerulonephritis.
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Pereira L, Machado A, Oliveira J, Almeida P, Bettencourt P. Infective Endocarditis Presenting as Acute Renal Failure and Unusual Complications. Intern Med 2015; 54:1259-63. [PMID: 25986267 DOI: 10.2169/internalmedicine.54.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infective endocarditis can be a diagnostic challenge. Few cases have so far reported infective endocarditis presenting as renal failure. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa and splenic abscess are rare complications of infective endocarditis. We herein report a case of an 80-year-old man admitted due to anorexia, malaise, edema of the legs and renal failure. A progressive degradation of the patient's renal function was documented and hemodialysis was started. Blood cultures revealed the presence of Enterococcus faecalis, and the patient was treated with ampicillin and gentamicin. The transesophageal echocardiogram findings showed pseudoaneurysms of the mitral-aortic intervalvular fibrosa and in the aortic root wall. Due to abdominal pain, an abdominal CT scan was performed and showed a cystic lesion compatible with splenic abscess. The patient received 6 weeks of antibiotic treatment. There was progressive clinical improvement and regression of the splenic abscess, but no recovery of the renal function. This report illustrates an unusual clinical presentation of infective endocarditis with unusual complications that were successfully treated with antibiotics.
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Affiliation(s)
- Luciano Pereira
- ����Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, 2.Nephrology Department, São João Hospital Center, Portugal
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Successful treatment of infectious endocarditis associated glomerulonephritis mimicking c3 glomerulonephritis in a case with no previous cardiac disease. Case Rep Nephrol 2014; 2014:569047. [PMID: 25506445 PMCID: PMC4259083 DOI: 10.1155/2014/569047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/06/2014] [Indexed: 11/20/2022] Open
Abstract
We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE.
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John SG, William P, Murugapandian S, Thajudeen B. Outcome of Patients with Infective Endocarditis who were Treated with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy. Clin Pract 2014; 4:670. [PMID: 25568769 PMCID: PMC4274487 DOI: 10.4081/cp.2014.670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/21/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022] Open
Abstract
Infective endocarditis is a potentially life threatening condition. It is associated with high mortality and morbidity resulting mostly due to cardiorespiratory failure. Extracorporeal membrane oxygenation is a modality of treatment used to support hypoxic respiratory failure especially in patients who are already on mechanical ventilation. Continuous renal replacement therapy is added mainly for maintaining fluid and electrolyte balance. Here we report a case series of patients diagnosed with infective endocarditis who were treated with combined extracorporeal membrane oxygenation and continuous renal replacement therapy. Three patients in the age group 20-60 years were admitted with clinical features suggestive of infective endocarditis. During the course of hospital stay they developed cardiorespiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation support for refractory hypoxia. It was complicated by heart failure, renal failure and fluid overload which required initiation of continuous renal replacement therapy. All the three patients succumbed in spite of the aggressive treatment. In addition to the role played by each complication, delayed start of continuous renal replacement therapy might have also contributed to the high mortality. Early initiation of continuous renal replacement therapy for management of fluid overload needs to be considered in the management of these critically ill patients.
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Affiliation(s)
- Santhosh G John
- Department of Medicine, University of Arizona Medical Center , Tucson, AZ, USA
| | - Preethi William
- Department of Medicine, University of Arizona Medical Center , Tucson, AZ, USA
| | | | - Bijin Thajudeen
- Department of Medicine, University of Arizona Medical Center , Tucson, AZ, USA
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Prediction of acute kidney injury within 30 days of cardiac surgery. J Thorac Cardiovasc Surg 2014; 147:1875-83, 1883.e1. [DOI: 10.1016/j.jtcvs.2013.06.049] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 05/27/2013] [Accepted: 06/21/2013] [Indexed: 11/19/2022]
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50
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Khalighi MA, Nguyen S, Wiedeman JA, Palma Diaz MF. Bartonella Endocarditis–Associated Glomerulonephritis: A Case Report and Review of the Literature. Am J Kidney Dis 2014; 63:1060-5. [DOI: 10.1053/j.ajkd.2013.10.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/23/2013] [Indexed: 11/11/2022]
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