Bookman Ian, Scholey James W, Jassal Sarbjit V, Lajoie Ginette, Herzenberg Andrew M
Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Am J Kidney Dis. 2004 Feb;43(2):e25-30. doi: 10.1053/j.ajkd.2003.10.027.
Glomerulonephritis secondary to endocarditis is uncommon and usually associated with valvular infection by blood culture-positive bacteria. We report 3 cases of necrotizing glomerulonephritis associated with culture-negative endocarditis caused by Bartonella henselae. Two of the patients presented with renal abnormalities and were investigated for endocarditis after results of renal biopsy. All 3 patients had an immune complex-mediated necrotizing and crescentic glomerulonephritis with mesangial and capillary wall deposition of immunoglobulin M (IgM), IgG, and C3. Electron microscopy showed immune-type electron-dense deposits in the mesangium and segmental subendothelial (2 cases) or subepithelial (1 case) deposits. Patients were treated with antibiotics, including azithromycin or doxycycline and ceftriaxone or tobramycin. In addition, 2 patients were administered steroids and 2 patients underwent valve replacement surgery. The 2 patients who underwent cardiac surgery were discharged from the hospital with stable renal function. The third patient died 4 months after hospital admission of renal failure. In conclusion, glomerulonephritis caused by B henselae endocarditis is an immune complex-mediated disease characterized by segmental necrotizing and crescentic glomerular lesions that can respond to aggressive medical and surgical therapy.
心内膜炎继发的肾小球肾炎并不常见，通常与血培养阳性细菌引起的瓣膜感染有关。我们报告3例由汉赛巴尔通体引起的与培养阴性心内膜炎相关的坏死性肾小球肾炎。其中2例患者出现肾脏异常，在肾活检结果出来后对心内膜炎进行了检查。所有3例患者均患有免疫复合物介导的坏死性新月体性肾小球肾炎，免疫球蛋白M（IgM）、IgG和C3在系膜和毛细血管壁沉积。电子显微镜显示系膜中有免疫型电子致密沉积物，2例为节段性内皮下沉积物，1例为上皮下沉积物。患者接受了抗生素治疗，包括阿奇霉素或多西环素以及头孢曲松或妥布霉素。此外，2例患者使用了类固醇，2例患者接受了瓣膜置换手术。接受心脏手术的2例患者出院时肾功能稳定。第3例患者在入院4个月后死于肾衰竭。总之，由汉赛巴尔通体心内膜炎引起的肾小球肾炎是一种免疫复合物介导的疾病，其特征为节段性坏死性和新月体性肾小球病变，对积极的药物和手术治疗有反应。
