Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Medicine (Baltimore). 2021 Aug 13;100(32):e26905. doi: 10.1097/MD.0000000000026905.
Several renal diseases are associated with infectious endocarditis. However, there are few reports on patients with granulomatosis with polyangiitis (GPA) associated with infectious endocarditis, and there is no consensus for appropriate treatment.
A 35 -years-old man with congenital ventricular septal defect presented severe anemia, hematuria and proteinuria. The blood and urine examinations showed elevated white blood cells (12,900 cells/μL), C-reactive protein level (13.1 mg/dL) and proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (11.0 IU/mL), severe anemia (hemoglobin: 6.1 g/dL) and renal dysfunction [estimated glomerular filtration rate (eGFR): 12.7 ml/min.1.78 m2 with hematuria and proteinuria].
The patient was diagnosed with crescentic glomerulonephritis with histological features of GPA associated with infectious endocarditis by renal biopsy and transthoracic echocardiography.
Antibacterial drugs (ampicillin-sulbactam) were administrated. No immunomodulating agents were used because immunosuppressive drugs may worsen infectious endocarditis. Subsequently, renal function and urinary findings improved. However, infectious endocarditis was not improved. Therefore, valve replacements and ventricular septal closure surgery were conducted.
Thereafter, his postoperative course was uneventful, renal function improved (eGFR: 64.3 ml/min.1.78 m2), and PR3-ANCA level normalized.
We reported a case report of PR3-ANCA positive glomerulonephritis with histological features of GPA associated with infectious endocarditis. Physicians might note this renal complication when they manage infectious endocarditis.
一些肾脏疾病与感染性心内膜炎相关。然而，关于伴有感染性心内膜炎的肉芽肿性多血管炎（GPA）患者，报道较少，且对于合适的治疗方法尚未达成共识。
一名 35 岁男性，患有先天性室间隔缺损，表现为严重贫血、血尿和蛋白尿。血液和尿液检查显示白细胞（12900 个/μL）、C 反应蛋白水平（13.1mg/dL）和蛋白酶 3-抗中性粒细胞胞质抗体（PR3-ANCA）水平（11.0IU/mL）升高，严重贫血（血红蛋白：6.1g/dL）和肾功能障碍[估计肾小球滤过率（eGFR）：12.7ml/min.1.78m2]。
通过肾活检和经胸超声心动图，该患者被诊断为新月体性肾小球肾炎，伴有 GPA 的组织学特征和感染性心内膜炎。
给予抗菌药物（氨苄西林-舒巴坦）。由于免疫抑制剂可能会加重感染性心内膜炎，因此未使用免疫调节药物。随后，肾功能和尿液检查结果改善。然而，感染性心内膜炎并未改善。因此，进行了瓣膜置换和室间隔封堵手术。
此后，患者术后恢复顺利，肾功能改善（eGFR：64.3ml/min.1.78m2），PR3-ANCA 水平恢复正常。
我们报告了一例 PR3-ANCA 阳性、伴有 GPA 组织学特征的肾小球肾炎伴感染性心内膜炎的病例。当医生治疗感染性心内膜炎时，可能需要注意这种肾脏并发症。
