Earlier Diagnosis of Subacute Streptococcus Viridans Endocarditis

Renal Complications of Bacterial Endocarditis

“…The incidence of renal insufficiency in endocarditis has diminished since the advent of effec tive antibiotic therapy, as has the percent of those dying of end-stage renal failure. Azotemia was reported in 20-75% of patients in the preatibiotic period [28][29][30][31], but in only 10-33% of patients in the postantibiotic period [28,32]. Similarly, some 15-25% of deaths in endocarditis were accompanied by uremia before antibiotics [33,34], whereas less than 5% now die with uremia [27,35,36].…”

“…Before I consider each of these individually, I want to emphasize that they rarely occur as isolated lesions in individual patients. As a rule, most patients will have a combination of more than one of these lesions with each at a different stage of severity [29,37], The course, prognosis, and response to therapy of the renal impairment will, therefore, represent the composite of the renal lesions present as well as the severity of each of the lesions. I also want to point out that Dr. Kim selected the cases and provided the illustrations used in this discussion.…”

“…Gross hematuria is considered suggestive of renal infarction, but firm supporting data for this are scarce and somewhat contradictory [29], Typically, infarcts occur prior to or early in the course of antibiotic therapy, but have been reported to occur months and years after the initial endocarditic episode [39], Renal infarction also occurs in some 10-15% of cases of right-sided endocarditis, pre sumably from septic emboli to pulmonary vessels which become thrombosed and the source of subsequent sys temic embolization [ 17. 40], The infarcted areas are ster ile and microscopically quite characteristic ( fig.…”

“…The chronic or scarred form ( fig. 3) consists of localized areas of scle rosis and fibrosis with capsular adhesions and fusion of adjacent lobules [44], As only parts of a few glomeruli are affected, the renal function is generally well preserved, and the urinalysis will reveal only microscopic hematuria or mild proteinuria [45], However, no urinary abnormal ities [46] as well as gross hematuria [29] have been reported to occur with focal glomerulonephritis.…”

“…56], In general, most patients with this lesion have a nephritic urine sediment with proteinuria, hematuria, and red blood cell casts. Gross hematuria can also occur [29], Eradication of the organism by appropriate antibiotic therapy usually results in the arrest or reversal of the dif fuse glomerulonephritic lesions and normalization of re nal function [45].…”