Ades L, Akposso K, Costa de Beauregard M A, Haymann J P, Mougenot B, Rondeau E, Sraer J D
Service de Néphrologie A and Laboratoire d'Anatomie Pathologique, Hôpital Tenon, Paris, France.
Transplantation. 1998 Sep 15;66(5):653-4. doi: 10.1097/00007890-199809150-00019.
Endocarditis-induced crescentic glomerulonephritis is a well-described complication in nontransplant patients. Its occurrence in transplant patients has not been reported to date.
A 50-year-old man who had received a renal allograft 13 years before and been treated with prednisone, 10 mg/day, was admitted for progressive renal failure, purpura, edema of the lower limbs, and fever.
Blood cultures isolated Streptococcus bovis and cardiac ultrasound examination revealed a 23-mm-large vegetation on the mitral valve. His plasma creatinine level was 478 micromol/L and his proteinuria was 5.5 g/day. A renal biopsy showed diffuse crescentic glomerulonephritis. Long-term antibiotic treatment and three methylprednisolone pulses were effective in treating the endocarditis and glomerulonephritis.
Endocarditis-induced glomerulonephritis is an immune-mediated disease that can also occur on a renal allograft. It is likely that a low daily dose of immunosuppressive treatment may have been a facilitating factor.
心内膜炎诱发的新月体性肾小球肾炎在非移植患者中是一种广为人知的并发症。迄今为止，其在移植患者中的发生情况尚未见报道。
一名50岁男性，13年前接受了肾移植，一直服用泼尼松，每日10毫克，因进行性肾衰竭、紫癜、下肢水肿和发热入院。
血培养分离出牛链球菌，心脏超声检查显示二尖瓣上有一个23毫米大的赘生物。他的血浆肌酐水平为478微摩尔/升，蛋白尿为每日5.5克。肾活检显示为弥漫性新月体性肾小球肾炎。长期抗生素治疗和三次甲泼尼龙冲击治疗对心内膜炎和肾小球肾炎有效。
心内膜炎诱发的肾小球肾炎是一种免疫介导的疾病，也可发生在肾移植受者身上。每日低剂量的免疫抑制治疗可能是一个促成因素。
