Zhou Xu-Jie, Liu Li-Jun, He Pei-Xin, Zhou Fu-de
Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China.
Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education.
Medicine (Baltimore). 2019 May;98(18):e15496. doi: 10.1097/MD.0000000000015496.
Glomerulonephritis triggered by a chronically infected graft is increasingly identified because of widely used implanted device. Removal of the aortic graft and sustained antibiotic therapy is the usual approach to maximize the chance of renal recovery, but as this case shows graft removal is not always possible.
A 35-year-old man with intractable and recurrent fever had acute renal failure in sustained antibiotic therapy.
Renal biopsy suggested crescentic glomerulonephritis. fluorodeoxyglucose/positron emission tomography-computed tomography showed increased metabolic activity at the site of aortic graft, reminding that chronic infection of an implanted graft can lead to severe glomerulonephritis. TGFBR2 c.1133G>T mutation was observed in mutation analysis, which was reported to be associated with Loeys-Dietz syndrome.
Although infection was properly controlled with appropriate antimicrobial treatment, his renal dysfunction did not improve. A short-term inclusion of low-dose corticosteroid significantly benefit without introducing harm.
He partly recovered from renal injury.
In patients with glomerulonephritis triggered by a long-duration infection, low-dose corticosteroid therapy may be considered when renal dysfunction secondary to nephritis does not improve after appropriate antimicrobial treatment.
由于植入装置的广泛使用，由慢性感染的移植物引发的肾小球肾炎越来越多地被发现。切除主动脉移植物并持续进行抗生素治疗是使肾脏恢复机会最大化的常用方法，但如本病例所示，移植物切除并非总是可行的。
一名35岁男性，患有顽固性反复发热，在持续抗生素治疗中出现急性肾衰竭。
肾活检提示新月体性肾小球肾炎。氟脱氧葡萄糖/正电子发射断层扫描 - 计算机断层扫描显示主动脉移植物部位代谢活性增加，提示植入移植物的慢性感染可导致严重的肾小球肾炎。在突变分析中观察到TGFBR2基因c.1133G>T突变，据报道该突变与洛伊斯 - 迪茨综合征相关。
尽管通过适当的抗菌治疗感染得到了有效控制，但他的肾功能障碍并未改善。短期加用低剂量皮质类固醇显著获益且未造成伤害。
他的肾损伤部分恢复。
对于由长期感染引发的肾小球肾炎患者，在适当的抗菌治疗后肾炎继发的肾功能障碍未改善时，可考虑低剂量皮质类固醇治疗。
