Hanf W, Serre J-E, Salmon J-H, Fabien N, Ginon I, Dijoud F, Trolliet P
Service de néphrologie-dialyse et transplantation, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, Pierre-Bénite cedex, France.
Rev Med Interne. 2011 Dec;32(12):e116-8. doi: 10.1016/j.revmed.2010.12.017. Epub 2011 Jan 31.
The association of positive cytoplasmic antineutrophil antibody (ANCA) necrotizing crescentic glomerulonephritis with endocarditis raises diagnostic issues. Indeed, it is often difficult to determine if the kidney injury is either secondary to an infectious disease or caused by an ANCA-associated small vessel vasculitis. We report a 59-year-old man admitted in nephrology for acute glomerular syndrome in whom the renal biopsy showed a crescentic necrotizing glomerulonephritis. A diagnosis of vasculitis was initially considered in the presence of high titer of ANCA (anti-proteinase 3). Because of associated Staphyloccocus aureus endocarditis the patient received both corticosteroids and antibiotics that allowed remission of both kidney injury and endocarditis. The renal presentation and the disappearance of ANCA support the infectious etiology of this glomerulonephritis rather than an ANCA-associated small vessel vasculitis. It is important to be cautious in the presence of ANCA positive extracapillary glomerulonephritis and endocarditis should be ruled out before initiation of corticosteroids that may be nevertheless necessary in severe acute glomerulonephritis.
阳性胞浆抗中性粒细胞抗体（ANCA）相关性坏死性新月体性肾小球肾炎合并心内膜炎会引发诊断问题。确实，通常很难确定肾脏损伤是继发于传染病还是由ANCA相关性小血管血管炎引起。我们报告一名59岁男性因急性肾小球综合征入住肾病科，其肾活检显示为新月体性坏死性肾小球肾炎。在存在高滴度ANCA（抗蛋白酶3）的情况下，最初考虑诊断为血管炎。由于合并金黄色葡萄球菌心内膜炎，患者接受了糖皮质激素和抗生素治疗，这使肾脏损伤和心内膜炎均得到缓解。肾脏表现及ANCA的消失支持该肾小球肾炎的感染性病因，而非ANCA相关性小血管血管炎。在出现ANCA阳性的毛细血管外肾小球肾炎时要谨慎，在开始使用糖皮质激素之前应排除心内膜炎，不过在严重急性肾小球肾炎中糖皮质激素可能是必要的。
