Renal lesion associated with infectious endocarditis
- VernacularTitle:感染性心内膜炎的肾脏损害
- Author:
Ruitong GAO
;
Yubing WEN
;
Hang LI
;
Xuewang LI
- Publication Type:Journal Article
- Keywords:
Endocarditis,bacterial;
Kidney disease
- From:
Chinese Journal of Nephrology
2005;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyse renal lesions associated with infectious endocarditis (IE). Methods Renal lesions associated with IE were reviewed. One hundred and fifty-five cases of IE were admitted to Peking Union Medical College Hospital from 1983 to 2004. C-square, t-test and Spearman's rank correlation analysis were performed. Results One hundred and thirty-seven(84.4%) cases of renal lesions associated with IE with an average age of 38 were found. The ratio of male to female was 1.4 and the period of pre-renal lesion was 4.8 months. Renal lesions included asymptomatic hematuria and/or proteinuria (71.0%), acute nephritic syndrome (6.5%), nephrotic syndrome (2.6% ), rapid progressive glomerulonephritis (1.3% ), renal embolism (1.3% ), isolated pyuria(3.2%), renal lesion not directly related to IE(2.6%). Acute renal insufficiency in 14 cases were caused by glomerulonephritis (5 cases), acute interstitial nephritis (5 cases), renal embolism(1 case), acute heart failure(5 cases) and the adverse effect of antibiotics (2 cases). Renal biopsy was taken in four patients. One diffuse proliferative glomerulonephritis, one membranous glomerulonephritis, one membrane-proliferative glomerulonephritis and one crescentic glomerulonephritis were found. All patients received antibiotic therapy and three of them stopped taking antibiotics, which was suspected to cause renal lesion. 20.4% cases received surgical therapy. 3.6% were treated with corticosteroid and/or immunoimpressive drugs and two cases of them were treated with intravenous bolus methylprednisolone. One case recieved anticoagulant therapy. 4.5% cases died. 43.8% cases with renal lesions were cured and 85.7% serum creatinine level decreased to normal. Statistical analysis showed that active treatment made no improvement on neither patients with or without renal lesion nor patients with different severity of renal lesion. Conclusions Renal lesions associated with IE are common. Most are asymptomatic hematuria and/or proteinuria. Acute nephritic syndrome, nephrotic syndrome, rapid progressive glomerulonephritis, renal embolism may also occur. It maybe appropriate to treat with corticosteroid, immunopressive drugs or intravenous bolus methylprednisolone for patients with rapid progressive glomerulonephritis under successful management of infective endocarditis.
