title: Update on endocarditis-associated glomerulonephritis.
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.
authors.affiliation: Nephropath, Little Rock, Arkansas, USA.
authors.forename: Christie L
authors.initials: CL
authors.lastname: Boils
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Samih H
authors.initials: SH
authors.lastname: Nasr
authors.affiliation: Nephropath, Little Rock, Arkansas, USA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Walker
authors.affiliation: University of Washington, Seattle, Washington, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Couser
authors.affiliation: Nephropath, Little Rock, Arkansas, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Larsen
mesh_terms: D058186:Acute Kidney Injury / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001021:Aortic Valve; D002648:Child; D002675:Child, Preschool; D003176:Complement C3 / Q000378:metabolism; D004696:Endocarditis / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D009336:Necrosis / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy; D014261:Tricuspid Valve; D055815:Young Adult
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D003176:Complement C3