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Currently filtering by tag: Endocarditis

Diagnose This (June 24, 2019)

Immunofluorescence shows C3 (2-3+), IgM (1+), kappa (trace) and lambda (trace). What is your diagnosis?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Renal Arterial Thromboemboli

Infective endocarditis can have numerous deleterious effects on the kidney.  One such renal complication is the formation of arterial thromboemboli.  The renal biopsy images, in this case, are from a 74-year-old man with an artificial heart valve who was being evaluated for acute renal failure.  Figure 1 shows an arterial cross section whose elastic laminae are highlighted using a Jones silver stain (see arrow).  The artery is distended by intraluminal fibrin and neutrophilic debris, consistent with aseptic thromboembolism.  Figure 2 shows the morphologic features of a renal cortical infarct, which was identified in the adjacent cortex.  A second complication of...

Twitter Poll (July 18, 2018)

ANSWER: D In a case series by Boils et al. which included 49 patients with GN due to IE, 28% of them had positive ANCA antibodies. Of note, in this study it was described that only 29 out of 49 patients had serology drawn for ANCA, 21 were negative (72%) and 8 (28%) were positive. Reference: Boils CL, et al. Update on endocarditis-associated glomerulonephritis. Kidney Int 2015; 87(6): 1241-1249.

Infective Endocarditis-Associated Glomerulonephritis

This renal biopsy was taken from a 35 year old male with history of intravenous drug abuse and MRSA tricuspid valve endocarditis, who developed acute kidney injury (Cr 4.7 mg/dl) and hematuria.  The biopsy shows focal and segmental necrotizing and crescentic lesions involving approximately 10% of the available glomeruli (Fig 1 and 2). Additionally, there is severe acute tubular injury with numerous red blood cell casts (Fig 3). Immunofluorescence (not shown) reveals weak immune complex deposition within the spectrum of pauci-immune disease (IgA= 1+; IgM= trace; C3= 1+; Kappa= trace; lambda= 1+), and no definitive deposits were evident by electron...


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...