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2015 ; 87
(6
): 1241-9
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Update on endocarditis-associated glomerulonephritis
#MMPMID25607109
Boils CL
; Nasr SH
; Walker PD
; Couser WG
; Larsen CP
Kidney Int
2015[Jun]; 87
(6
): 1241-9
PMID25607109
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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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