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Klarić D, Žutelija M, Šenjug P, Klarić M, Galešić Ljubanović D. Crescentic Glomerulonephritis Due to Enterococcal Endocarditis. J Pers Med 2023; 13:1212. [PMID: 37623463 PMCID: PMC10455847 DOI: 10.3390/jpm13081212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Glomerulonephritis following an enterococcal endocarditis is an extremely rare and life-threatening condition. We present the case of a 71-year-old patient with rapidly progressive glomerulonephritis following enterococcal endocarditis after surgical replacement of the aortic valve. The combination of antibiotic therapy, corticosteroid therapy and haemodialysis led to an improvement in renal function; however, the severity of cardiac deterioration resulted in a fatal outcome.
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Affiliation(s)
- Dragan Klarić
- Department of Nephrology and Dialysis, Zadar General Hospital, Bože Peričića 5, 23000 Zadar, Croatia; (D.K.)
| | - Marta Žutelija
- Department of Nephrology and Dialysis, Zadar General Hospital, Bože Peričića 5, 23000 Zadar, Croatia; (D.K.)
| | - Petar Šenjug
- Unit of Nephropathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, School of Medicine, University of Zegreb, 10000 Zagreb, Croatia;
- Institute of Pathology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Marta Klarić
- School of Medicine, University of Rijeka, Ulica Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Danica Galešić Ljubanović
- Unit of Nephropathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, School of Medicine, University of Zegreb, 10000 Zagreb, Croatia;
- Institute of Pathology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
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Awazu M, Miyahara M, Chiga M, Hashiguchi A, Takahashi H. A girl with membranous nephropathy associated with ventriculoperitoneal shunt infection. CEN Case Rep 2023; 12:130-134. [PMID: 36087243 PMCID: PMC9892401 DOI: 10.1007/s13730-022-00732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
Glomerulopathy associated with shunt infection is commonly membranoproliferative glomerulonephritis, whereas the causative organisms of secondary membranous nephropathy are usually viruses. We report a case of membranous nephropathy associated with shunt infection. The patient was born at 29-week gestation with a birth weight of 1178 g. Ventriculoperitoneal shunt surgery had been performed for congenital hydrocephalus. Thereafter, she had experienced seven shunt infections. At the age 13 years, proteinuria was detected in a school urinary screening. Urinalysis at our hospital demonstrated 3 + protein and 3 + blood. Laboratory testing demonstrated a serum creatinine 0.5 m/dl, albumin 2.5 g/dl, C-reactive protein (CRP) 13.7 mg/dl, and C3 182 mg/dl. Prior to repeat urinalysis, the patient developed vomiting and was admitted with suspected shunt infection. On admission, her body temperature was 36.0 ºC. Physical examination was unremarkable other than small stature and a palpable mass in the left upper quadrant. Urinalysis demonstrated 2 + protein and 1 + blood with no cells or casts. The urinary protein excretion was 3 g/day. Abnormal laboratory tests included erythrocyte sedimentation rate 102 mm/hr, CRP 11.67 mg/dl, IgG 2442 mg/dl, C3 177 mg/dl, and C4 44 mg/dl. Antibiotic therapy was initiated for a presumptive diagnosis of shunt infection and the shunt catheter was removed. Cultures obtained after antibiotic administration were negative. Proteinuria persisted after control of the shunt infection. Histology of a renal biopsy demonstrated membranous nephropathy with diffuse granular IgG staining and subepithelial deposits. Three possible pathomechanisms for her membranous nephropathy were considered.
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Affiliation(s)
- Midori Awazu
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
- Department of Pediatrics, Tokyo Ohtsuka Metropolitan Hospital, 2-8-1, Minamiohtsuka, Toshima-ku, Tokyo, Japan.
| | - Maiko Miyahara
- Department of Pediatrics, Tokyo Ohtsuka Metropolitan Hospital, 2-8-1, Minamiohtsuka, Toshima-ku, Tokyo, Japan
| | - Michiko Chiga
- Department of Pediatrics, Tokyo Ohtsuka Metropolitan Hospital, 2-8-1, Minamiohtsuka, Toshima-ku, Tokyo, Japan
| | - Akinori Hashiguchi
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Takahashi
- Department of Pediatrics, Tokyo Ohtsuka Metropolitan Hospital, 2-8-1, Minamiohtsuka, Toshima-ku, Tokyo, Japan
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L'Imperio V, Ajello E, Garozzo M, Tosoni A, Ferrario F, Pagni F. Immunosuppression in idiopathic membranous nephropathy: A double-edge sword. Int J Immunopathol Pharmacol 2016; 29:775-777. [PMID: 27382985 DOI: 10.1177/0394632016655170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 05/24/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vincenzo L'Imperio
- The Department of Medicine and Surgery, University Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Elena Ajello
- The Department of Medicine and Surgery, University Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Maurizio Garozzo
- The Renal Unit, Santa Marta e Santa Venera Hospital, Acireale, Catania, Italy
| | | | - Franco Ferrario
- The Department of Medicine and Surgery, University Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabio Pagni
- The Department of Medicine and Surgery, University Milan Bicocca, San Gerardo Hospital, Monza, Italy
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Tandon T, Mujtaba M, Mishler D, Phillips C, Sharfuddin A. Early Enterococcus-associated acute postinfectious glomerulonephritis after kidney transplant. Clin Kidney J 2015; 7:426-7. [PMID: 25852929 PMCID: PMC4377814 DOI: 10.1093/ckj/sfu069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Teena Tandon
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - M Mujtaba
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - Dennis Mishler
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - Carrie Phillips
- Department of Pathology , Indiana University School of Medicine , Indianapolis, IN , USA
| | - Asif Sharfuddin
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
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Bayer AS, Theofilopoulos AN. Immunopathogenetic aspects of infective endocarditis. Chest 1990; 97:204-12. [PMID: 2403898 DOI: 10.1378/chest.97.1.204] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- A S Bayer
- Division of Adult Infectious Diseases, Harbor-UCLA Medical Center, Torrance
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Maisch B. Autoreactive mechanisms in infective endocarditis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1989; 11:439-56. [PMID: 2694410 DOI: 10.1007/bf00201881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Infective endocarditis is not a simple interaction between a microbial agent and a cardiac valve. For the infection of a non-bacterial thrombotic vegetation, predisposition is required which is at least partially operative by a decreased suppressor T cell activity. During infection, peripheral blood natural killer cell activity is decreased, but normalizes under anti-microbial therapy. Non-major histocompatibility complex-restricted lymphocytotoxicity to isolated heart cells can be present in one third of patients. Circulating immune complexes normalize during therapy. They may be the cause of many clinical symptoms of infective endocarditis. Anti-bacterial and also anti-sarcolemmal antibodies which are cross-reactive to the bacterium are secreted in a polyclonal immune response. Anti-sarcolemmal antibodies which are cytolytic in vitro in the presence of complement may partly explain the myocardial factor of heart failure in patients with only marginal valve incompetence due to the endocarditic vegetation.
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Affiliation(s)
- B Maisch
- Department of Internal Medicine-Cardiology, Philipps-University Marburg, Federal Republic of Germany
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Bayer AS, Theofilopoulos AN. Immune complexes in infective endocarditis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1989; 11:457-69. [PMID: 2694411 DOI: 10.1007/bf00201882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A S Bayer
- UCLA School of Medicine, Adult Infectious Disease Department, Harbor-UCLA Medical Center, Torrance 90509
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