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Renal disease in the setting of infective endocarditis or an infected ventriculoatrial shunt

Author
Jai Radhakrishnan, MD, MS
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Patients with infective endocarditis (IE) can develop several forms of renal disease: a bacterial infection-related immune complex-mediated glomerulonephritis, which can also occur with an infected ventriculoatrial shunt [1-4]. In addition, a drug-induced acute interstitial nephritis or, with aminoglycosides, acute kidney injury (due to acute tubular necrosis) can develop.

Based upon the population studied and the severity of disease, additional renal histologic lesions may be observed. Among kidneys evaluated at autopsy, for example, localized infarcts, particularly due to septic emboli, as well as renal cortical necrosis have been described [5].

The frequency of renal involvement in patients was illustrated in a retrospective study of over 200 consecutive episodes of bacterial endocarditis [6]. Approximately one-third of patients developed acute kidney injury (of any cause), a complication observed most often among older patients and those with Staphylococcus aureus infection.

GLOMERULONEPHRITIS

A variety of organisms may be involved in patients developing glomerulonephritis. The most common are Staphylococcus aureus in acute infective endocarditis (IE), Streptococcus viridans in subacute IE, and Staphylococcus epidermidis in shunt nephritis.

The histologic findings in the glomerulonephritis are similar to those in poststreptococcal glomerulonephritis or membranoproliferative glomerulonephritis: hypercellularity (due in part to the influx of circulating inflammatory cells) and immune deposits in the glomerular capillary wall. Diffuse crescent formation can occur [7]. (See "Staphylococcus-associated glomerulonephritis in adults" and "Poststreptococcal glomerulonephritis".)

   

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Literature review current through: Nov 2016. | This topic last updated: Fri May 09 00:00:00 GMT+00:00 2014.
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References
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