Bartonella Endocarditis-Associated Glomerulonephritis Presenting as Acute Renal Failure
- AKI: Mechanisms - Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
- Cheloff, Abraham Zachary, New York City Health and Hospitals Bellevue, New York, New York, United States
- Wen, Shawn, New York City Health and Hospitals Bellevue, New York, New York, United States
- Driscoll, Caitlin, New York City Health and Hospitals Bellevue, New York, New York, United States
Acute kidney injury (AKI) in the setting of mitral valve endocarditis is often due to cardiorenal syndrome secondary to valvular dysfunction. We report a case of acute renal failure caused by Bartonella endocarditis-associated glomerulonephritis.
A 28-year-old man from Nicaragua with a history of mitral valve replacement presented with left arm weakness. Brain MRI revealed a subacute right parietal lobe infarct. TTE and TEE showed thickened mitral valve leaflets and a high transvalvular pressure gradient, consistent with prosthetic valve endocarditis. Empiric antibiotics were initiated. Cultures remained negative throughout admission. On hospital day (HD)13, Bartonella henselae IgG was >1:2560, and antibiotics were changed to rifampin and doxycycline.
Creatinine on admission was 1.3 (baseline 0.8), and stabilized at 1.1. On HD13, the patient’s Cr uptrended to 1.5. Concurrently, he developed acute hypoxemic respiratory failure with evidence of volume overload, initially thought to be cardiorenal syndrome and the patient was diuresed. Despite reaching euvolemia, his Cr continued to uptrend to 6.4. UA with moderate hematuria and proteinuria. 24-hour protein was 1.3g. FeUrea was 47%, which was less consistent with pre-renal AKI and prompted an intrinsic AKI workup. Results notable for positive ANA, low C3 and C4, and positive PR3, which led to the clinical diagnosis of infectious glomerulonephritis. Renal biopsy to confirm the diagnosis was deferred in favor of definitive treatment with mitral valve replacement. The patient’s creatinine improved to 2.9 after surgery, and he was discharged with a presumed diagnosis of C3-mediated Bartonella glomerulonephritis. He continued 3 months of doxycycline and 6 weeks of rifampin and his creatinine normalized within 2 weeks of discharge.
Acute renal failure in the setting of endocarditis can be multifactorial, and it can be challenging to determine the etiology. The concomitant development of respiratory failure, valvular dysfunction, and acute renal failure was initially compelling for cardiorenal syndrome. However, worsening renal function after achieving euvolemia, along with positive PR3, hypocomplementemia, proteinuria, and hematuria in the setting of Bartonella endocarditis was later more consistent with infectious glomerulonephritis that resolved upon definitive treatment.