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Abstract: TH-PO716

Membranoproliferative Glomerulonephritis Associated with Hemophilus parainflunezae Endocarditis: A Rare Presentation

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Amjad, Momina, Albany Medical Center, Albany, New York, United States
  • Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States

We present a case of acute renal failure due to diffuse membranoproliferative glomerulonephritis in the setting of HACEK organism mitral valve infective endocarditis (IE).

Case Description

A 56-year-old with year old male with no significant past medical history was transferred to the ICU for renal failure, anemia and hypotension. He had a three month history of fevers, night sweats, reddish brown urine and 15 Ib weight loss. Physical exam was notable for confusion, respiratory distress on 14 liters oxygen, a pansystolic murmur over the mitral area and +2 bilateral pedal edema. He had profound microcytic anemia on initial presentation with a hemoglobin of 4 g/dL, alongside leukocytosis 29 10x9/L. Metabolic panel was notable for Creatinine 5.28, BUN 162, PO4 10.2 and albumin 2.6.

He underwent continuous renal replacement therapy (CRRT) for uremic encephalopathy in the setting of hypotension. Further investigation revealed 2.5g proteinuria ove 24 hours and RBC casts in the urine analysis. C3 was 38.4 mg/dL, C4 was undetectable and rheumatoid factor was more than 115. Hepatitis C was not detected and other rheumatologic serologies were unremarkable. The patient was started on empiric plasmapheresis for concern of cryoglobulinemic glomerulonephritis (GN).

A transthoracic echocardiogram showed a large mitral valve (MV) vegetation, severe MV regurgitation, and a small pericardial effusion. Blood cultures grew gram negative rods after 79 hours, which were finalized to Hemophilus parainfluenzae. Plasmapheresis was stopped. Due to persistent encephalopathy, MRI brain was obtained which showed septic emboli.

His kidney biopsy revealed diffuse membranoproliferative GN with C3/IgM strongly positive. His final diagnosis was mixed cryoglobulinemia and MPGN in the setting of Hemophilus endocarditis. He was maintained on IV ceftriaxone and eventually underwent surgical mitral valve replacement.


Acute renal failure related to IE-associated glomerulonephritis (IEAGN) has been reported in literature, with varying pathophysiological mechanisms, including one third of patients having anti-neutrophil cytoplasmic antibody (ANCA) positivity. To our knowledge, there are no reported cases of IE caused by HACEK organisms associated with MPGN. This case highlights a unique presentation that may be missed.