Necrotizing glomerulonephritis caused by Bartonella henselae endocarditis

Am J Kidney Dis. 2004 Feb;43(2):e25-30. doi: 10.1053/j.ajkd.2003.10.027.

Abstract

Glomerulonephritis secondary to endocarditis is uncommon and usually associated with valvular infection by blood culture-positive bacteria. We report 3 cases of necrotizing glomerulonephritis associated with culture-negative endocarditis caused by Bartonella henselae. Two of the patients presented with renal abnormalities and were investigated for endocarditis after results of renal biopsy. All 3 patients had an immune complex-mediated necrotizing and crescentic glomerulonephritis with mesangial and capillary wall deposition of immunoglobulin M (IgM), IgG, and C3. Electron microscopy showed immune-type electron-dense deposits in the mesangium and segmental subendothelial (2 cases) or subepithelial (1 case) deposits. Patients were treated with antibiotics, including azithromycin or doxycycline and ceftriaxone or tobramycin. In addition, 2 patients were administered steroids and 2 patients underwent valve replacement surgery. The 2 patients who underwent cardiac surgery were discharged from the hospital with stable renal function. The third patient died 4 months after hospital admission of renal failure. In conclusion, glomerulonephritis caused by B henselae endocarditis is an immune complex-mediated disease characterized by segmental necrotizing and crescentic glomerular lesions that can respond to aggressive medical and surgical therapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bartonella Infections / complications*
  • Bartonella Infections / diagnosis
  • Bartonella henselae* / immunology
  • Biopsy
  • Endocarditis, Bacterial / complications*
  • Female
  • Glomerulonephritis / etiology*
  • Glomerulonephritis / immunology
  • Glomerulonephritis / pathology
  • Humans
  • Male
  • Microscopy, Electron
  • Microscopy, Fluorescence
  • Middle Aged
  • Necrosis