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Kidney Week

Abstract: FR-PO232

Infection-Related Glomerulonephritis

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Thomas, Dominik, University of Utah Health, Salt Lake City, Utah, United States
  • Revelo Penafiel, Monica Patricia, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

Infection-related (IE) glomerulonephritis (GN) can be associated with viral or bacterial infections and vary from asymptomatic microscopic hematuria to rapidly progressive GN with acute kidney injury requiring emergent dialysis. This patient presents with months of nonspecific symptoms and developed rapidly worsening renal function. He was ultimately found to have bacterial endocarditis.

Case Description

50 year old male presented with progressive functional decline, cough, and unintentional weight loss in the setting of pancytopenia for 6 months and worsening creatinine (Cr) and hematuria over the preceding two weeks. He saw hematology and underwent imaging and bone biopsy with negative results. Serum Cr on admission was 2.75mg/dl but two weeks prior was 0.73 md/dl. UA showed 50-100 RBCs and urine microscopy revealed numerous dysmorphic RBCs. Urine protein to creatine ratio was 2974 mg/g (15-68mg/g). Renal biopsy showed endocapillary proliferative GN with dominant C3 deposits, a fibro-cellular crescent and patchy mixed interstitial inflammatory infiltrate with focal acute tubular injury. Infectious workup resulted in positive blood cultures for streptococcus mutans. He was started on Ceftriaxone. Transesophageal echocardiogram showed mobile mass on the posterior leaflet measuring 1.2 x 0.3 cm. He underwent mitral valve replacement. Cr trended down to 0.75 mg/dl along with improving proteinuria and hematuria.

Discussion

Sub acute bacterial endocarditis can present with non specific symptoms delaying diangosis. Treatment of IE-associated GN includes antibiotics and sometimes valve replacement. Control of the infection may not always be associated with a favorable outcome. One case series shows 21 percent of patients died; of the surviving patients, 10 percent progressed to end-stage kidney disease, 37 percent had persistent kidney function impairment, and only 32 percent had complete kidney recovery. Early recognition and prompt treatment is crucial for recovery.

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