Infective endocarditis accompanying crescentic glomerulonephritis: A report of two cases and review of the literature

Objective To study the treatment of infective endocarditis-induced crescentic glomerulonephritis and its prognosis. Methods Clinicopathological characteristics,treatment and prognosis of 2 patients with infective endocarditis acompanying crescentic glomerulonephritis admitted to our department were analyzed with the related literature reviewed. Results The 2 patients were adult males with a history of congenital vulvular disease of heart(VDH) and diagnosed with infective endocarditis according to B-ultrasonography and blood culture.Laboratory test showed that the proteinuria and occult blood were 3+,the 24h urinary protein was 3.8g,the peak creatinine level was 673.5μmol/L,and renal biopsy revealed 31 intact glomeruli and 23 newly formed crescents,including 11 cellular crescents in patient 1.One month after the patient was treated with penicillin,low dose corticosteroid and hemodialysis,his renal function was still abnormal.Three days after he was treated with intravenous methylprednisolone,0.5g per day for 3 consecutive days,his renal function returned to normal.The patient was followed up for 2 years,during which his creatinine level and urinary protein decreased to 68μmol/L and 1+,and occult blood became negative.Laboratory test showed that the proteinuria was 1+,the occult blood was negative,the peak creatinine level was 216.3μmol/L,and renal biopsy revealed 26 intact glomeruli and 14 newly formed crescents in patient 2.After long-term anti-infection treatment and valve replacement,his renal function returned to normal.The patient was followed up for 2 years,during which his creatinine level decreased to 86.6μmol/L and routine urine test was negative. Conclusion Corticosteroid therapy,even boost corticosteroid therapy,is recommended for patients with cellular crescents while anti-infection therapy and valve replacement are recommended for those with fibrous crescents.The prognosis of the 2 patients reported in this study is quite good.