Table 1. Summary of the clinical, laboratory, and pathology features of patients with acute glomerulonephritis in the setting of bacterial endocarditis treated by plasmapheresis (including current case report).
| McKenzie et al, 1979 [13] | Rovzar et al. 1986 [11] | Daimon et al. 1998 [14] | Couzi et al., 2004 [15] | Halpin et al. 2016 (current report) | |
|---|---|---|---|---|---|
| Age (years)/sex | 53/M | 25/M | 50/F | 58/M | 57/M |
| Urinalysis | Not reported | Hematuria, proteinuria, red and white blood cell casts | Hematuria, proteinuria | Hematuria, proteinuria (1.61 gm/24 h) | Hematuria, proteinuria, red blood cell casts |
| Initial serum creatinine | 10.4 mg/dL | 3.9 mg/dL | 2.0 mg/dL | 13.8 mg/dL | 3.0 mg/dL |
| C3/C4 levels | Low/low | Low/low | Low/low | Low/normal | Low/low |
| Serological workup | Nonreactive anti-GBM antibody | Nonreactive ANA, ANCA, anti-GBM antibody, and cryoglobulin Elevated rheumatoid factor titer (1 : 640) |
Nonreactive ANA, anti-DS-DNA antibody, ANCA, and anti-GBM antibody Elevated IgG and IgA levels; elevated rheumatoid factor level (56 IU/mL) |
Nonreactive ANA, anti-DS-DNA antibody, ASO, ANCA, anti-GBM antibody, and cryoglobulin | Nonreactive anti-DS-DNA antibody, ANCA, anti-GBM antibody, and cryoglobulin Elevated ANA titer (1 : 160), elevated RF level (> 130 IU/mL) |
| C1q level* | Elevated | Elevated | Elevated | Undetected | Elevated |
| Blood culture | Not reported (dental work) | Streptococcus viridans | Streptococcus viridans | Streptococcus parasanguis | Streptotoccus mutans |
| Echocardiographic location of vegetations | Aortic valve | Aortic valve | Tricuspid valve | Mitral and aortic valve | Tricuspid and mitral valve |
| Kidney biopsy findings | LM: Focal segmental crescentic glomerulonephritis (60% of glomeruli) IF: C3 and IgM granular deposits |
LM: Fibrocellular crescentic glomerulonephritis (50% of glomeruli) IF: C3, IgG, and IgM granular deposits |
LM: Fibrocellular crescentic glomerulonephritis (64% of glomeruli) IF: C3 and C1q granular deposits |
LM: Fibrocellular crescentic glomerulonephritis (50% of glomeruli) IF: No complement or immunoglobulin deposits |
LM: Diffuse proliferative glomerulonephritis (endocapillary and mesangial proliferation) IF: C3, C1q, IgG, and IgM granular deposits |
| Antibiotics | Cloxacillin | Penicillin and gentamicin (initiated on day 2) | Piperacillin, amoxicillin, cefazolin | Ceftriaxone and vancomycin (initiated on day 1) | Ceftriaxone |
| Immunosuppressive drugs | Prednisolone | Prednisone 2 mg/kg/day and azathioprine 1 mg/kg/day (initiated on day 16 due to rising serum creatinine) | None | Prednisone 1 mg/kg/day (initiated on day 13) | Methylprednisolone 250 – 500 mg initiated on day 4 for 5 days followed by prednisone 1 mg/kg/day tapered over 14 days |
| Hemodialysis | Initiated on day –1 | Not required | Not required | Initiated on day 1 and discontinued on day 29 | Not required |
| Plasmapheresis | Initiated on day –8 for a total of 5 sessions; 2-L exchange using 5% albumin | Initiated on day 5 and 6 and then thrice weekly for a total of 11 sessions; 3-L exchange per (90-minute) session using 5% salt-poor albumin | Initiated on day 20 for a total of 5 sessions; 3-L exchange per session | Initiated on day 27 and discontinued on day 65 for a total of 14 sessions; 3-L exchange per session with albumin | Initiated on day 11 for a total of 7 sessions; 4.5-L exchange per session with 50% albumin and 50% fresh frozen plasma |
| Cardiac surgery | Aortic valve replacement on day –75 | Not required | Fistula closure and vegetation excision on day 60 | Valvular replacement on day 90 | Not required |
| Duration of follow-up | 132 days | 43 days | 10 months | 2 years | 13 months |
| Last serum creatinine | 1.8 mg/dL | 1.8 mg/dL | 1.3 mg/dL | 2.7 mg/dL | 0.8 mg/dL |
M = male; F = female; LM = light microscopy; IF = immunofluorescence; *The C1q binding assay measures circulating immune complexes. Note: Conversion factor for creatinine in mg/dL to mmol/L, multiply by 88.4.