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