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

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


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.


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: Dec 2016. | This topic last updated: Fri May 09 00:00:00 GMT+00:00 2014.
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  1. Neugarten J, Baldwin DS. Glomerulonephritis in bacterial endocarditis. Am J Med 1984; 77:297.
  2. Arze RS, Rashid H, Morley R, et al. Shunt nephritis: report of two cases and review of the literature. Clin Nephrol 1983; 19:48.
  3. Rose, BD. Pathophysiology of Renal Disease, 2nd ed, McGraw-Hill, New York City 1987. p.229.
  4. Haffner D, Schindera F, Aschoff A, et al. The clinical spectrum of shunt nephritis. Nephrol Dial Transplant 1997; 12:1143.
  5. Majumdar A, Chowdhary S, Ferreira MA, et al. Renal pathological findings in infective endocarditis. Nephrol Dial Transplant 2000; 15:1782.
  6. Conlon PJ, Jefferies F, Krigman HR, et al. Predictors of prognosis and risk of acute renal failure in bacterial endocarditis. Clin Nephrol 1998; 49:96.
  7. Kannan S, Mattoo TK. Diffuse crescentic glomerulonephritis in bacterial endocarditis. Pediatr Nephrol 2001; 16:423.
  8. Griffin KA, Schwartz MM, Korbet SM. Pulmonary-renal syndrome of bacterial endocarditis mimicking Goodpasture's syndrome. Am J Kidney Dis 1989; 14:329.
  9. Wu HC, Wen YK, Chen ML, Fan CS. Pulmonary-renal syndrome in a patient with bacterial endocarditis. J Formos Med Assoc 2005; 104:588.
  10. Nolan CM, Abernathy RS. Nephropathy associated with methicillin therapy. Prevalence and determinants in patients with staphylococcal bacteremia. Arch Intern Med 1977; 137:997.
  11. Neilson EG. Pathogenesis and therapy of interstitial nephritis. Kidney Int 1989; 35:1257.
  12. Moyssakis I, Tektonidou MG, Vasilliou VA, et al. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med 2007; 120:636.
  13. Tarter L, Yazdany J, Moyers B, et al. Clinical problem-solving. The heart of the matter. N Engl J Med 2013; 368:944.
  14. KDIGO. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int Suppl 2012; 2:209. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO-GN-Guideline.pdf (Accessed on December 23, 2013).