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CASE REPORT
Plasmapheresis and corticosteroids in infective endocarditis-related crescentic glomerulonephritis
  1. Kunal Malhotra and
  2. Preethi Yerram
  1. Division of Nephrology, University of Missouri School of Medicine, Columbia, Missouri, USA
  1. Correspondence to Dr. Kunal Malhotra, malhotrak{at}health.missouri.edu

Abstract

Infective endocarditis (IE)-related glomerulonephritis (GN) typically resolves with the treatment of IE. A 59-year-old woman with a baseline creatinine of 0.7 mg/dL presented with rash on her legs, night sweats and weight loss for 3 weeks. Further evaluation revealed IE. Her blood cultures grew gamma-haemolytic streptococcus, which subsequently cleared on appropriate antibiotic therapy. Her creatinine, however, progressively worsened requiring haemodialysis. Kidney biopsy showed immune complex-mediated necrotising and crescentic GN. She was started on plasmapheresis (PE) and high-dose steroids with rapid taper, with subsequent improvement in her creatinine to 0.8 mg/dL. She subsequently had aortic valve replacement and ventricular septal defect closure. She did not improve as expected with antibiotic therapy but turned around dramatically with steroids and PE. Our case supports the possible beneficial role of PE and steroids in IE-related crescentic GN that worsens despite appropriate antibiotic therapy, although the risks of immunosuppression and aggravating endocarditis need to be considered.

  • acute renal failure
  • dialysis
  • valvar diseases
  • infections
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Footnotes

  • Contributors Research idea and study design: KM and PY; data acquisition: KM; data analysis/interpretation: KM and PY; and supervision or mentorship: PY. KM takes responsibility that this study has been reported honestly, accurately and transparently, and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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