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Abstract: TH-PO578

Crescenteric Glomerulonephritis Leading to Diagnosis of Culture Negative Endocarditis

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Author

  • Lai, Huanchun N., McLaren Health Care Corp, Flint, Michigan, United States
Introduction

Infective endocarditis-associated glomerulonephritis (IEAGN) as the initial presentation leading to diagnosis of afebrile, culture negative and negative serologic workup endocarditis.

Case Description

A 64-year-old male with history of CAD s/p remote CABG and hypertension presented with cough, dyspnea and worsening lower extremity edema. He was found to have a serum creatinine of 2.27mg/dL, hematuria and nephrotic range proteinuria 4.1g raising concerns for glomerular etiologies. Serologic workup showed mildly positive ANA 1:80, normal C3 and C4, ANCA, MPO, PR3, SPEP, and K/L ratio all negative, and no Bence Jones proteins. Hep B and C studies were negative. Outpatient kidney biopsy was obtained and demonstrated crescenteric glomerulonephritis on light microscopy with C3 dominant deposits on immunofluorescence favoring infection-associated glomerulonephritis and raising question for endocarditis. Patient readmitted for further inpatient workup. TEE showed evidence of vegetation on right coronary cusp. Blood culture negative. Histoplasmosis, Bartonella, and Q fever, Antistrep O, HIV, mycoplasma, and legionella were all negative. The patient was treated with six weeks of intravenous ceftriaxone followed with prednisone taper. Patient had improvement of symptoms and improvement of renal function.

Discussion

IEAGN develops as sequalae of acute or subacute endocarditis. In literature there has not been a case with acute renal injury with proteinuria and hematuria as the initial presentation of endocarditis. This case highlights the importance of renal biopsy in guidance of treatment of cresenteric glomerulitis in a case of culture negative, serology negative endocarditis.

Necrotizing cresenteric glomerulonephritis seen with Jones silver stain. Active crescents involve 55-60% of non-obsolescent glomeruli sampled for light microscopy.