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

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

[1]  S. Krishnamurthy,et al.  Severe acute kidney injury in children owing to infective endocarditis-associated immune complex glomerulonephritis: a report of two cases , 2017, Paediatrics and international child health.

[2]  X. Ao,et al.  TAK-242, a Toll-Like Receptor 4 Antagonist, Protects against Aldosterone-Induced Cardiac and Renal Injury , 2015, PloS one.

[3]  W. Couser,et al.  Update on endocarditis-associated glomerulonephritis , 2015, Kidney international.

[4]  W. Couser,et al.  The etiology of glomerulonephritis: roles of infection and autoimmunity. , 2014, Kidney international.

[5]  Zhi-Hong Liu,et al.  The role of renal damage on cardiac remodeling in patients with diabetic nephropathy. , 2013, Clinical Nephrology.

[6]  D. Himmelstein,et al.  Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study , 2013, PloS one.

[7]  C. Hassager,et al.  In infectious endocarditis patients mortality is highly related to kidney function at time of diagnosis: a prospective observational cohort study of 231 cases. , 2009, European journal of internal medicine.

[8]  E. Ahmed,et al.  Crescentic glomerulonephritis associated with bacterial endocarditis--antibiotics alone may be sufficient. A case report. , 2005, JPMA. The Journal of the Pakistan Medical Association.

[9]  S. Kannan,et al.  Diffuse crescentic glomerulonephritis in bacterial endocarditis , 2001, Pediatric Nephrology.

[10]  J. Neugarten,et al.  Glomerulonephritis in bacterial endocarditis. , 1984, The American journal of medicine.

[11]  R. Erbel,et al.  Infective endocarditis with negative blood cultures. , 2007, British medical journal.

[12]  G. Baehr.  GLOMERULAR LESIONS OF SUBACUTE BACTERIAL ENDOCARDITIS , 1912, The Journal of experimental medicine.