The Immune Complex Glomerulonephritis of Bacterial Endocarditis

Infective endocarditis with glomerulonephritis associated with cat chlamydia (C. psittaci) infection.

“…The occurrence of glomerulonephritis in association with infective endocarditis is well recognised (Gutman et al, 1972). This nephritis is probably the result of deposition of immune complexes of which the antigen is derived from the infective organism (Levy and Hong, 1973;Perez et al, 1976).…”

Renal Complications of Bacterial Endocarditis

“…Initially, the clinical and morphologic features of the renal involvement were attributed to emboli from an infected valve with the kidney lesions representing injury and reaction to repeated microembolization. However, the presumed embolic etiology of the renal lesions was questioned particularly when focal glomerulonephritis was reported in cases of right-sided endocarditis [16,17], Indirect evidence for an immune etiology of the renal lesion was first advanced from the observation of low serum complement in 8 cases of endocarditis with mod erate to severe renal disease, in whom the complement level became normal as renal insufficiency abated [18], Subsequently, the demonstration of circulating immune complexes [19], electron-dense, immunoglobulin and complement deposits along the glomerular basement membrane [20], and ultimately the isolation of bacterial antigen [21] and antibody [22] from the glomerular eluate provided convincing evidence for an immune-mediated etiology of the glomerulonephritic lesions of bacterial endocarditis [23].…”

“…Electron microscopy reveals subepithelial, intramembranous. subendothelial, and mesangial deposits [20], It has been noted that the deposits are mainly subepithelial in bacteremic cases, particularly in those of staphylococcal origin, subendothelial in blood culture negative cases, and me sangial in those who have responded to antibiotic therapy [2. 20], Immunofluorescent studies reveal IgG, IgA.…”

Hematuria, Proteinuria, and Hypertension in a Patient with Multiple Organ System Disease

“…8], it is unusual for such patients to be afebrile. In this regard, Gutman et al [9] reported a series of 9 patients with evidence of immune complex glomerulone phritis of bacterial endocarditis. 6 of 9 patients were cul ture negative, yet only 1 of 9 patients was afebrile.…”

“…Third, the markedly elevated white cell count reverted to normal without antimicrobial therapy, a highly unusual event for untreated bacterial endocardi tis. In summary, culture-negative endocarditis in an afe brile drug abuser is distinctly unusual [6,[8][9][10]. Finally, elevated cryoglobulins with culture-negative bacterial en docarditis have not been reported.…”