Neugarten J, Gallo G R, Baldwin D S
Am J Kidney Dis. 1984 Mar;3(5):371-9. doi: 10.1016/s0272-6386(84)80086-4.
For a modern assessment of the clinical and morphologic features of glomerulonephritis accompanying bacterial endocarditis, postmortem and renal biopsy files were reviewed for the years 1965 to 1979, a period of changing epidemiology, etiology, and therapeutic regimens in infective endocarditis. The incidence of glomerulonephritis in 107 patients examined at postmortem was 22.4%; focal glomerulonephritis was present in 8.4%, diffuse glomerulonephritis in 14%. Glomerulonephritis occurred as frequently in acute as in subacute bacterial endocarditis. Staphylococcus aureus, which has replaced Streptococcus viridans as the predominant etiology of fatal bacterial endocarditis, was frequently associated with glomerulonephritis, especially in parenteral drug abusers. Renal functional impairment due to focal glomerulonephritis did not necessitate dialysis or contribute to the death of any patient. Presentation with advanced renal insufficiency due to diffuse glomerulonephritis was associated with both failure of antibiotic therapy to eradicate infection and failure to recover renal function. In patients with diffuse glomerulonephritis and less severe impairment of renal function, antibiotic therapy was successful in achieving bacteriologic cure, and complete recovery of renal function occurred in the majority. Features of persistent glomerular disease were frequent in patients with diffuse glomerulonephritis long after bacteriologic cure of endocarditis.
为了对伴有细菌性心内膜炎的肾小球肾炎的临床和形态学特征进行现代评估，我们回顾了1965年至1979年的尸检和肾活检档案，这一时期感染性心内膜炎的流行病学、病因和治疗方案都在发生变化。在107例尸检患者中，肾小球肾炎的发生率为22.4%；局灶性肾小球肾炎占8.4%，弥漫性肾小球肾炎占14%。肾小球肾炎在急性细菌性心内膜炎和亚急性细菌性心内膜炎中的发生率相同。金黄色葡萄球菌已取代草绿色链球菌成为致命性细菌性心内膜炎的主要病因，它常与肾小球肾炎相关，尤其是在静脉药物滥用者中。局灶性肾小球肾炎导致的肾功能损害并不需要透析，也没有导致任何患者死亡。因弥漫性肾小球肾炎出现晚期肾功能不全与抗生素治疗未能根除感染以及肾功能未能恢复有关。在弥漫性肾小球肾炎且肾功能损害较轻的患者中，抗生素治疗成功实现了细菌学治愈，大多数患者肾功能完全恢复。在细菌性心内膜炎细菌学治愈后的很长一段时间里，弥漫性肾小球肾炎患者中持续性肾小球疾病的特征很常见。
