Table 1:  Renal Lesions Associated with Bacterial Endocarditis

 

 

Frequency

Complement

Elevated Serum Ig

Pathology

Urinalysis

Clinical Course

Immune-complex glomerulonephritis

10-15% of IE

Low

IgG, IgM, IgA

Focal/diffuse glomerulonephritis

RBC casts

Dysmorphic RBC

Improves after ABx

ABx-induced acute interstitial nephritis

 

+

Normal

IgG, IgM, IgA

+/- IgE

Tubulointerstitial infiltration

+/-Eosinophils

Worsens after ABx 

Embolic renal infarction

56% of the autopsy

Normal

None

Septic embolus in artery

Nonspecific

Variable

Renal abscess

Uncommon

Normal

None

Abscess

Nonspecific

Dependent on drainage

Thrombotic (DIC)

 

Normal

None

Thrombotic microangiopathy

Nonspecific

Variable

Acute tubular necrosis

 

Normal

None

Tubular necrosis

Granular casts,

epitherial cell casts

UNa>20mEq/L

Improves after supportive treatment

MRSA glomerulonephritis

(superantigen-related nephritis)

 

Normal

IgA, IgG

Mesangial/endocapillary proliferative glomerulonephritis, tubulointestitial nephritis

Nephrotic range proteinuria

Improves after ABx

  Ig: Immunoglobulin        DIC: Disseminated Intravascular Coagulopathy

  ABx: Antibiotics            UNa: Urine Sodium

  RBC: Red blood cell      Nonspecific: Variable degree of proteinuria, hematuria, pyuria or normal