Immunosuppressive therapy and plasmapheresis in rapidly progressive glomerulonephritis associated with bacterial endocarditis.
A 25-year-old male presented with new cardiac murmurs and acute renal insufficiency. Blood cultures grew Streptococcus viridans and appropriate antibiotic therapy was initiated. A renal biopsy revealed diffuse proliferative glomerulonephritis with crescents involving more than 50% of the glomeruli. Treatment with antibiotics, plasmapheresis, and steroids resulted in renal recovery that paralleled reductions in circulating immune complexes. The rationale for this therapeutic approach is discussed, as well as a review of two similar case reports. These experiences suggest a possible role for plasmapheresis and immunosuppressive drugs in patients who develop rapidly progressive glomerulonephritis as a complication of bacterial endocarditis.
M A
MA
Rovzar
J L
JL
Logan
D A
DA
Ogden
A R
AR
Graham
D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis; D001379:Azathioprine / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000276:immunology; D005921:Glomerulonephritis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D010956:Plasmapheresis; D011241:Prednisone / Q000008:administration & dosage*; D013290:Streptococcal Infections / Q000150:complications*; D013997:Time Factors
D000936:Antigen-Antibody Complex; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone