Abstract
Endocarditis associated with antiPR3 ANCA and acute kidney injure generates a challenge in its diagnosis and treatment. In order to make a review about that combination, we presented a patient with necrotizing glomerulonephritis produced by a Enterococcus faecalis´s subacute endocarditis and antiPR3 ANCA positive.Differential diagnosis is made between an acute kidney failure produced by ANCA´s vasculitis vs necrotizing glomerulonephritis by endocarditis. Frequently it is necessary to make a biopsy to get a diagnosis. Negative immunofluorescence will guide to vasculitis associated ANCA, while positive immune complexes will guide to poststreptococcal glomerulonephritis.
Other challenge that generates the association of acute kidney disease, endocarditis and antiPR3 ANCA is the treatment. ANCA positive can prompt to start immunosuppressant treatments. However, in the context of endocarditis, it could be inadvisable and even dangerous to use it. For this reason, it is controversial the use of immunosuppressant in combination with antibiotics in the acute process, in contrast with the use of only antibiotics. In the current paper we collect the 19 reports in the literature about endocarditis associated with antiPR3 ANCA, the treatment and the renal evolution of each patient. We concluded, generally, a better improvement of kidney function in patients treated with only antibiotics than those patients treated with the combination of antibiotics and corticoids. However, there are so few reports that we can´t consider significant the different between both treatment groups.
References
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Disponible en: https://doi.org/10.2169internalmedicine.51.8081
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3. Lee LC, Lam KK, Lee CT, Chen JB, Tsai TH, Huang SC. “Full house” proliferative glomerulonephritis: an unreported presentation of subacute infective endocarditis. J Nephrol. 2007;20(6):745–749.
4. Peng H, Chen WF, Wu C, Chen YR, Peng B Paudel S, et al. Culture negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung. BCM Nephrol [Internet]. 2012;26:174.
Disponible en: https://doi.org/10.1186/1471-2369-13-174
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Disponible en: https://doi.org/10.3899/jrheum.101322
6. Bauer A, Jabs WJ, Sufke S, Maass M, Kreft B. Vasculitic purpura with antineutrophil cytoplasmic antibody-positive acute renal failure in a patient with Streptococcus bovis case and Neisseria subflava bacteremia and subacute endocarditis. Clin Nephrol [Internet]. 2004;62:144–8. Disponible en: https://doi.org/10.5414/CNP62144
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10. Zeledon JI, McKelvey RL, Servilla KS, Hofinger D, Konstantinov KN, Kellie S, Sun Y, Massie LW, Hartshorne MF, Tzamaloukas AH. Glomerulonephritis causing acute renal failure during the course of bacterial infections: Histological varieties, potential pathogenetic pathways and treatment. Int Urol Nephrol [Internet[. 2008;40(2):461–70. Disponible en: https://doi.org/10.1007/s11255-007-9323-6
11. Konstantinov KN, Harris AA, Hartshorne MF, Tzamaloukas AH. Symptomatic Anti-Neutrophil Cytoplasmic Antibody-Positive Disease Complicating Subacute Bacterial Endocarditis: To Treat or Not to Treat? Case Rep Nephrol Urol [Internet]. 2012;2(1):25–32.
Disponible en: https://doi.org/10.1159/000339409
12. Kishimoto N, Mori Y, Yamahara H, Kijima Y, Nose A, Uchiyama-Tanaka Y, Tokoro T, Nagata T, Umeda Y, Takahashi N, Yoshida H, Matsubara H. Cytoplasmic antineutrophil cytoplasmic antibody positive pauci-immune glomerulonephritis associated withinfectious endocarditis. Clin Nephrol [Internet]. 2006;66:447–54.
Disponible en: https://doi.org/10.5414 CNP66447
13. Hanf W, Serre JE, Salmon JH, Fabien N, Ginon I, Dijoud F, Trolliet P. Rapidly progressive ANCA positive glomerulonephritis as the presenting feature of infectious endocarditis. Rev Med Interne [Internet]. 2011;32(12):e116–8.
Disponible en: https://doi.org/10.1016j.revmed.2010.12.017
14. Messiaen T, Lefebvre C, Zech F, Cosyns JP, Jadoul M. ANCA-positive rapidly progressive glomerulonephritis: there may be more to the diagnosis than you think! Nephrol Dial Transplant [Internet]. 1997;12(4):839–41. Disponible en: https://doi.org/10.1093/ndt/12.4.839
15. Wagner J, Andrassy K, Ritz E. Is vasculitis in subacute bacterial endocarditis associated with ANCA? Lancet [Internet]. 1991;337(8744):799–800.
Disponible en: https://doi.org/10.1016/0140-6736(91)91427-V
16. Haseyama T, Imai H, Komatsuda A, Hamai K, Ohtani H, Kibira S et al. Proteinase-3- antineutrophil cytoplasmic antibody (PR3-ANCA) positive crescentic glomerulonephritis in a patient with Down’s syndrome and infectious endocarditis. Nephrol Dial Transpl [Internet]. 1998;13(8):2143–6.
Disponible en: https://doi.org/10.1093/ndt/13.8.2142
17. Veerappan I, Prabitha EN, Abraham A, Theodore S, Abraham G. Double ANCA-positive vasculitis in a patient with infective endocarditis. Indian J Nephrol [Internet]. 2012;22(6):469–72.
Disponible en: https://doi.org/10.4103/0971-4065.106057
18. Ghosh GC, Sharma B, Katageri B, Bhardwaj M. ANCA positivity in a patient with infective endocarditis associated glomerulonephritis: A diagnostic dilemma. Yale J Biol Med [Internet]. 2014;87(3):373–7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144291/
19. Sugiyama H, Sahara M, Imai Y, Ono M, Okamoto K, Kikuchi K, et al. Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis. Cardiology [Internet]. 2009;114(3):208–11.
Disponible en: https://doi.org/10.1159/000228645
20. Chirinos JA, Corrales-Medina VF, Garcia S, Lichtstein DM, Bisno AL, Chakko S. Endocarditis associated with antineutrophil cytoplasmic antibodies: A case report and review of the literature. Clin Rheumatol [Internet]. 2007;26(4):590–5. Disponible en: https://doi.org/10.1007s10067-005-0176-z
21. Robbins, Cotran. Structural and functional pathology. 7th ed. Amsterdam: Elsevier; 2005. p. 959–1024.
22. Soto A, Jorgensen C, Oksman F, Noel LH, Sany J. Endocarditis associated with ANCA. Clin Exp Rheumatol. 1994;12(2):203–4.
23. Ardalan MR, Trillini M. Infective endocarditis mimics ANCA associated glomerulonephritis. Caspian J Intern Med. 2012;3(3):496–9.
24. Infection-related glomerulonephritis. Kidney inter [Internet]. 2012;Suppl KDIGO Clinical Practice Guideline for Glomerulonephritis:200–8.
Disponible en: http://www.kdigo.orgclinical_practice_guidelines/
pdf/KDIGO-GN-Guideline.pdf
Disponible en: https://doi.org/10.2169internalmedicine.51.8081
2. Gentry LO, Khoshdel A. New approaches to the diagnosis and treatment of infective endocarditis. Tex Hear Inst J. 1989;16(4):250–7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC326529/pdf/thij00059-0032.pdf
3. Lee LC, Lam KK, Lee CT, Chen JB, Tsai TH, Huang SC. “Full house” proliferative glomerulonephritis: an unreported presentation of subacute infective endocarditis. J Nephrol. 2007;20(6):745–749.
4. Peng H, Chen WF, Wu C, Chen YR, Peng B Paudel S, et al. Culture negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung. BCM Nephrol [Internet]. 2012;26:174.
Disponible en: https://doi.org/10.1186/1471-2369-13-174
5. Mitchell UH, McCormick IA, Kelsall JT. Positive cytoplasmic antineutrophil cytoplasmic antigen with PR3 specificity glomerulonephritis in a patient with subacute bacterial endocarditis. J Rheumatol [Internet]. 2011;38(7):1527–28. ]
Disponible en: https://doi.org/10.3899/jrheum.101322
6. Bauer A, Jabs WJ, Sufke S, Maass M, Kreft B. Vasculitic purpura with antineutrophil cytoplasmic antibody-positive acute renal failure in a patient with Streptococcus bovis case and Neisseria subflava bacteremia and subacute endocarditis. Clin Nephrol [Internet]. 2004;62:144–8. Disponible en: https://doi.org/10.5414/CNP62144
7. Fukuda M, Motokawa M, Usami T, Oikawa T, Morozumi K, Yoshida A, Kimura G. PR3-ANCA-positive crescentic necrotizing glomerulonephritis accompanied by isolated pulmonic valve infective endocarditis, with reference to previous reports of renal pathology. Clin Nephrol [Internet]. 2006;66:202–9. Disponible en: https://doi.org/10.5414/CNP66202
8. Subra JF, Michelet C, Laporte J, Carrere F, Reboul P, Cartier F, Saint Andre JP, Chevailler A. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) in the course of subacute bacterial endocarditis with glomerular involvement, coincidence or association? Clin Nephrol. 1998;49(1):15–18.
9. de Corla-Souza A, Cunha, BA. Streptococcal viridans subacute bacterial endocarditis associated with antineutrophil cytoplasmic autoantibodies (ANCA). Hear Lung [Internet]. 2003;32(2):140–3. Disponible en: https://doi.org/10.1067/mhl.2003.2
10. Zeledon JI, McKelvey RL, Servilla KS, Hofinger D, Konstantinov KN, Kellie S, Sun Y, Massie LW, Hartshorne MF, Tzamaloukas AH. Glomerulonephritis causing acute renal failure during the course of bacterial infections: Histological varieties, potential pathogenetic pathways and treatment. Int Urol Nephrol [Internet[. 2008;40(2):461–70. Disponible en: https://doi.org/10.1007/s11255-007-9323-6
11. Konstantinov KN, Harris AA, Hartshorne MF, Tzamaloukas AH. Symptomatic Anti-Neutrophil Cytoplasmic Antibody-Positive Disease Complicating Subacute Bacterial Endocarditis: To Treat or Not to Treat? Case Rep Nephrol Urol [Internet]. 2012;2(1):25–32.
Disponible en: https://doi.org/10.1159/000339409
12. Kishimoto N, Mori Y, Yamahara H, Kijima Y, Nose A, Uchiyama-Tanaka Y, Tokoro T, Nagata T, Umeda Y, Takahashi N, Yoshida H, Matsubara H. Cytoplasmic antineutrophil cytoplasmic antibody positive pauci-immune glomerulonephritis associated withinfectious endocarditis. Clin Nephrol [Internet]. 2006;66:447–54.
Disponible en: https://doi.org/10.5414 CNP66447
13. Hanf W, Serre JE, Salmon JH, Fabien N, Ginon I, Dijoud F, Trolliet P. Rapidly progressive ANCA positive glomerulonephritis as the presenting feature of infectious endocarditis. Rev Med Interne [Internet]. 2011;32(12):e116–8.
Disponible en: https://doi.org/10.1016j.revmed.2010.12.017
14. Messiaen T, Lefebvre C, Zech F, Cosyns JP, Jadoul M. ANCA-positive rapidly progressive glomerulonephritis: there may be more to the diagnosis than you think! Nephrol Dial Transplant [Internet]. 1997;12(4):839–41. Disponible en: https://doi.org/10.1093/ndt/12.4.839
15. Wagner J, Andrassy K, Ritz E. Is vasculitis in subacute bacterial endocarditis associated with ANCA? Lancet [Internet]. 1991;337(8744):799–800.
Disponible en: https://doi.org/10.1016/0140-6736(91)91427-V
16. Haseyama T, Imai H, Komatsuda A, Hamai K, Ohtani H, Kibira S et al. Proteinase-3- antineutrophil cytoplasmic antibody (PR3-ANCA) positive crescentic glomerulonephritis in a patient with Down’s syndrome and infectious endocarditis. Nephrol Dial Transpl [Internet]. 1998;13(8):2143–6.
Disponible en: https://doi.org/10.1093/ndt/13.8.2142
17. Veerappan I, Prabitha EN, Abraham A, Theodore S, Abraham G. Double ANCA-positive vasculitis in a patient with infective endocarditis. Indian J Nephrol [Internet]. 2012;22(6):469–72.
Disponible en: https://doi.org/10.4103/0971-4065.106057
18. Ghosh GC, Sharma B, Katageri B, Bhardwaj M. ANCA positivity in a patient with infective endocarditis associated glomerulonephritis: A diagnostic dilemma. Yale J Biol Med [Internet]. 2014;87(3):373–7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144291/
19. Sugiyama H, Sahara M, Imai Y, Ono M, Okamoto K, Kikuchi K, et al. Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis. Cardiology [Internet]. 2009;114(3):208–11.
Disponible en: https://doi.org/10.1159/000228645
20. Chirinos JA, Corrales-Medina VF, Garcia S, Lichtstein DM, Bisno AL, Chakko S. Endocarditis associated with antineutrophil cytoplasmic antibodies: A case report and review of the literature. Clin Rheumatol [Internet]. 2007;26(4):590–5. Disponible en: https://doi.org/10.1007s10067-005-0176-z
21. Robbins, Cotran. Structural and functional pathology. 7th ed. Amsterdam: Elsevier; 2005. p. 959–1024.
22. Soto A, Jorgensen C, Oksman F, Noel LH, Sany J. Endocarditis associated with ANCA. Clin Exp Rheumatol. 1994;12(2):203–4.
23. Ardalan MR, Trillini M. Infective endocarditis mimics ANCA associated glomerulonephritis. Caspian J Intern Med. 2012;3(3):496–9.
24. Infection-related glomerulonephritis. Kidney inter [Internet]. 2012;Suppl KDIGO Clinical Practice Guideline for Glomerulonephritis:200–8.
Disponible en: http://www.kdigo.orgclinical_practice_guidelines/
pdf/KDIGO-GN-Guideline.pdf
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