Infective Endocarditis-induced Crescentic Glomerulonephritis Dramatically Improved after Removal of Vegetations and Valve Replacement

Infective endocarditis (IE) is associated with poor prognosis and higher mortality. IE‑induced glomerulonephritis, especially crescentic glomerulonephritis (IE‑CGN) with renal dysfunction, is an independent risk factor for mortality. For the treatment of IE‑CGN, many therapeutic strategies including antibiotics alone, antibiotics combined with corticosteroid, immunosuppressive agents, plasmapheresis, or cardiac surgery have been applied and obtained various results. [2] Here, we reported a case of CGN with progressive renal failure secondary to IE in which the renal function was dramatically improved by the treatment of surgical valve replacement and antibiotics. A 68‑year‑old woman was admitted to the Beijing Anzhen Hospital on July 28, 2011 with lower extremity edema and pink urine over 1 month. Four months ago, she had a fever about 38°C about 2 weeks, and then her body temperature gradually came back to normal after antibiotics therapy. She has been diagnosed having " rheumatic heart disease with mitral regurgitation " about 50 years, but her heart function was relatively good. On physical examination, her temperature was 36.8°C, blood pressure was 110/70 mmHg, and pulse rate was 80 beats/min. A Grade IV/VI systolic murmur at the cardiac apex with radiation to left armpit, a Grade IV/VI systolic murmur in the second right intercostal space with radiation to carotid artery, and a diastolic murmur in the third left intercostal space was heard. The patient had clubbed fingers. Laboratory tests showed that the white cell count (WBC) count was 11,330 /μl with 85% neutrophils, and the hemoglobin level was 81 g/L in the peripheral blood. Urinalysis found >100 red blood cells (RBCs)/hpf and 15–25 WBCs/hpf. Urinary protein excretion was 2.0 g/d. The serum creatinine level was 263 μmol/L, which was 62 μmol/L one month ago. Urine osmolality after 12 hours of water deprivation was 275 mOsm/kg·H 2 O. sedimentation rate was 32 mm/h. Blood culture of 3 times showed no bacterial growth. Echocardiogram revealed two very large vegetations (both 16 mm) on aortic valve and two small vegetations (both 8.9 mm) on mitral valve, with moderate mitral regurgitation, moderate aortic stenosis, and regurgitation [Figure 1]. The vegetations on aortic valve moved back and forth between aorta and left ventricle accompanied heartbeat. Hence, infection endocarditis associated with renal lesion was diagnosed. Since the blood culture was negative, according to the literature, [3] it maybe culture‑negative endocarditis. On hospital day 6, the patient's serum creatinine level was increased to 365.4 μmol/L. In order to understand the …