July 13, 2017
Crescentic glomerulonephritis is most commonly an autoimmune-related glomerulonephritis (e.g. ANCA, anti-GBM disease, lupus nephritis). However, a recent case series (reference below) found that more than 50% of cases of endocarditis associated glomerulonephritis show a crescentic pattern of glomerulonephritis without endocapillary proliferation. Further, 28% of the patients with endocarditis-associated glomerulonephritis had positive serologic studies for ANCA. Therefore, it is important to maintain a high index of suspicion for infective endocarditis associated glomerulonephritis considering the potential adverse outcome if a patient with endocarditis was mistakenly treated for ANCA-associated glomerulonephritis with cytotoxic agents in lieu of antibiotics.
Reference: Boils CL, Nasr SH, Walker PD, Couser WG, Larsen CP. Update on endocarditis-associated glomerulonephritis. Kidney Int. 2015 Jun;87(6):1241-9.