scholarly journals Rare Bacteria Infecting the Heart and Affecting the Kidney of a Young Child

2017 ◽  
Vol 7 (3) ◽  
pp. 138-143 ◽  
Author(s):  
Gurinder Kumar ◽  
Alyaa Saeed Al Ali ◽  
Namrata Gulzar Bhatti
Keyword(s):  
Infective Endocarditis ◽  
Young Child ◽  
Blood Culture ◽  
Renal Biopsy ◽  
Clinical Picture ◽  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Necrotizing Glomerulonephritis ◽  
Complex Deposition ◽  
Rare Bacteria

Rare bacteria can lead to infective endocarditis, which may lead to renal involvement as severe glomerulonephritis. We report our experience of a 12-year-old child who presented with infective endocarditis and blood culture-grown Gemella morbillorum – a rarely reported bacteria. The clinical picture was further complicated with severe glomerulonephritis. Renal biopsy was suggestive of crescentic glomerulonephritis. The child was managed with antibiotics, steroids, and plasmapheresis and responded well to the treatment. To our knowledge, this is the first report of G. morbillorum endocarditis with immune complex deposition and necrotizing glomerulonephritis in a child.

scholarly journals Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ryan Burkhart ◽  
Nina Shah ◽  
Michael Abel ◽  
James D. Oliver ◽  
Matthew Lewin
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Immune Complex ◽  
Lupus Erythematosus ◽  
Membranous Nephropathy ◽  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Rapid Decline ◽  
Secondary Membranous Nephropathy

Renal involvement in systemic lupus erythematosus (SLE) is usually immune complex mediated and may have multiple different presentations. Pauci-immune necrotizing and crescentic glomerulonephritis (NCGN) refers to extensive glomerular inflammation with few or no immune deposits that may result in rapid decline in renal function. We report a case of a 79-year-old Hispanic male with a history of secondary membranous nephropathy (diagnosed by renal biopsy 15 years previously) who was admitted with acute kidney injury and active urinary sediment. P-ANCA titers and anti-myeloperoxidase antibodies were positive. The renal biopsy was diagnostic for NCGN superimposed on a secondary membranous nephropathy. A previous diagnosis of SLE based on American College of Rheumatology criteria was discovered via Veteran’s Administration records review after the completion of treatment for pauci-immune NCGN. ANCAs are detected in 20–31% of patients with SLE. There may be an association between SLE and ANCA seropositivity. In patients with lupus nephritis and biopsy findings of necrotizing and crescentic glomerulonephritis, without significant immune complex deposition, ANCA testing should be performed. In patients with secondary membranous nephropathy SLE should be excluded.

scholarly journals ANCA - Positive Churg Strauss Syndrome with Necrotizing Crescentic glomerulonephritis

JMS SKIMS ◽  
2009 ◽  
Vol 12 (1) ◽  
pp. 21-23
Author(s):  
A R Reshi ◽  
I A Wani ◽  
K A Banday ◽  
Iqbal Lone ◽  
M M Wani ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Biopsy ◽  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Eosinophilic Infiltration ◽  
Small Vessel Vasculitis ◽  
Churg Strauss Syndrome ◽  
Necrotizing Crescentic Glomerulonephritis ◽  
Strauss Syndrome ◽  
Churg Strauss

Churg Strauss Syndrome (CSS) is an ANCA associated small vessel vasculitis with eosinophilic infiltration. Renal involvement is frequent, although usually mild. We report a case of CSS with renal failure. Renal biopsy revealed necrotizing cresentic glomerulonephritis, eosonophilic arteritis and diffuses eosinophilic infiltration. Patient was successfully treated with combination of corticosteroids and cyclophosphamide. (JMed Sci 2009;12(1):21-23)

scholarly journals Deep learning-based framework for the distinction of membranous nephropathy: a new approach through hyperspectral imagery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tianqi Tu ◽  
Xueling Wei ◽  
Yue Yang ◽  
Nianrong Zhang ◽  
Wei Li ◽  
...  
Keyword(s):  
Deep Learning ◽  
Renal Biopsy ◽  
Membranous Nephropathy ◽  
Learning Algorithm ◽  
Hyperspectral Imagery ◽  
Chinese Patients ◽  
Support Vector ◽  
Deep Learning Algorithm ◽  
The Difference ◽  
Complex Deposition

Abstract Background Common subtypes seen in Chinese patients with membranous nephropathy (MN) include idiopathic membranous nephropathy (IMN) and hepatitis B virus-related membranous nephropathy (HBV-MN). However, the morphologic differences are not visible under the light microscope in certain renal biopsy tissues. Methods We propose here a deep learning-based framework for processing hyperspectral images of renal biopsy tissue to define the difference between IMN and HBV-MN based on the component of their immune complex deposition. Results The proposed framework can achieve an overall accuracy of 95.04% in classification, which also leads to better performance than support vector machine (SVM)-based algorithms. Conclusion IMN and HBV-MN can be correctly separated via the deep learning framework using hyperspectral imagery. Our results suggest the potential of the deep learning algorithm as a new method to aid in the diagnosis of MN.

Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study

2021 ◽  
pp. 1-9
Author(s):  
Lorenzo Roberto Suardi ◽  
Arístides de Alarcón ◽  
María Victoria García ◽  
Antonio Plata Ciezar ◽  
Carmen Hidalgo Tenorio ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Culture Negative ◽  
Spanish Cohort

scholarly journals Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Lohit Garg ◽  
Sagar Gupta ◽  
Abhishek Swami ◽  
Ping Zhang
Keyword(s):  
Immune Complex ◽  
Systemic Vasculitis ◽  
Renal Involvement ◽  
Morphological Properties ◽  
High Dose ◽  
Cocaine Use ◽  
Immune Mediated ◽  
History Of ◽  
Psychotropic Effects ◽  
Complex Deposition

Levamisole is an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytosis have been well described. Despite systemic vasculitis in this setting, renal involvement is uncommon. We report here a case of ANCA positive systemic vasculitis with biopsy proven immune complex mediated glomerulonephritis likely secondary to levamisole/cocaine. A 40-year-old Caucasian male with no past medical history presented with 3-week history of fatigue, skin rash, joint pains, painful oral lesions, oliguria, hematuria, worsening dyspnea on exertion, and progressive lower extremity edema. He had a history of regular tobacco and cocaine use. Lab testing revealed severe anemia, marked azotemia, deranged electrolytes, and 4.7 gm proteinuria. Rheumatologic testing revealed hypocomplementemia, borderline ANA, myeloperoxidase antibody, and positive atypical p-ANCA. Infectious and other autoimmune workup was negative. Kidney biopsy was consistent with immune mediated glomerulonephritis and showed mesangial proliferation and immune complex deposition consisting of IgG, IgM, and complement. High dose corticosteroids and discontinuing cocaine use resulted in marked improvement in rash, mucocutaneous lesions, and arthritis. There was no renal recovery and he remained hemodialysis dependent.

Eosinophile Granulomatose mit Polyangiitis (eGPA) in der Niere: Glomerulonephritis und interstitielle Nephritis

2021 ◽  
Vol 3 (1) ◽  
pp. 12-14
Author(s):  
Sibylle von Vietinghoff
Keyword(s):  
Renal Biopsy ◽  
Membranous Nephropathy ◽  
Late Onset ◽  
Renal Involvement ◽  
Acute Interstitial Nephritis ◽  
Consensus Conference ◽  
Alveolar Haemorrhage ◽  
Small Vessel Vasculitis ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Granulomatose Mit Polyangiitis

<b>Objective:</b> Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by asthma, hypereosinophilia and ANCA positivity in 40% of patients. Renal involvement is rare and poorly described, leading to this renal biopsy-proven based study in a large EGPA cohort. <b>Methods:</b> We conducted a retrospective multicentre study including patients fulfilling the 1990 ACR criteria and/or the 2012 revised Chapel Hill Consensus Conference criteria for EGPA and/or the modified criteria of the MIRRA trial, with biopsy-proven nephropathy. <b>Results:</b> Sixty-three patients [27 women, median age 60 years (18–83)] were included. Renal disease was present at vasculitis diagnosis in 54 patients (86%). ANCA were positive in 53 cases (84%) with anti-MPO specificity in 44 (83%). All patients had late-onset asthma. Peripheral neuropathy was present in 29 cases (46%), alveolar haemorrhage in 10 (16%). The most common renal presentation was acute renal failure (75%). Renal biopsy revealed pauci-immune necrotizing GN in 49 cases (78%). Membranous nephropathy (10%) and membranoproliferative GN (3%) were mostly observed in ANCA-negative patients. Pure acute interstitial nephritis was found in six cases (10%); important interstitial inflammation was observed in 28 (44%). All patients received steroids with adjunctive immunosuppression in 54 cases (86%). After a median follow-up of 51 months (1–296), 58 patients (92%) were alive, nine (14%) were on chronic dialysis and two (3%) had undergone kidney transplantation. <b>Conclusion:</b> Necrotizing pauci-immune GN is the most common renal presentation in ANCA-positive EGPA. ANCA-negative patients had frequent atypical renal presentation with other glomerulopathies such as membranous nephropathy. An important eosinophilic interstitial infiltration was observed in almost 50% of cases.

scholarly journals Anca-associated crescentic glomerulonephritis in a child with isolated renal involvement

2019 ◽  
Vol 41 (2) ◽  
pp. 293-295
Author(s):  
Mehtap Ezel Çelakıl ◽  
Burcu Bozkaya Yücel ◽  
Umay Kiraz Özod ◽  
Kenan Bek
Keyword(s):  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Immunosuppressive Treatment ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Normal Serum ◽  
Laboratory Findings ◽  
Elevated Creatinine ◽  
Systemic Symptoms ◽  
Mild Clinical Presentation ◽  
Normal Serum Creatinine

ABSTRACT Pauci-immune glomerulonephritis (GN) is more common in elderly people compared to children and the etiology is not completely understood yet. Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in 80% of the patients. We report a case of a 7-year-old girl who presented with malaise and mildly elevated creatinine diagnosed as ANCA-associated pauci-immune crescentic glomerulonephritis with crescents in 20 of 25 glomeruli (80%). Of these 20 crescents, 12 were cellular, 4 fibrocellular, and 4 globally sclerotic. She did not have purpura, arthritis, or systemic symptoms and she responded well to initial immunosuppressive treatment despite relatively severe histopathology. The patient was given three pulses of intravenous methylprednisolone (30 mg/kg on alternate days) initially and continued with cyclophosphamide (CYC; 2 mg/kg per day) orally for 3 months with prednisone (1 mg/kg per day). In one month, remission was achieved with normal serum creatinine and prednisone was gradually tapered. The case of this child with a relatively rare pediatric disease emphasizes the importance of early and aggressive immunosuppressive treatment in patients with renal-limited ANCA-associated pauci-immune crescentic GN even if with a mild clinical presentation. As in our patient, clinical and laboratory findings might not always exactly reflect the severity of renal histopathology and thus kidney biopsy is mandatory in such children to guide the clinical management and predict prognosis.

scholarly journals Blood culture time to positivity in non-β-hemolytic streptococcal bacteremia as a predictor of infective endocarditis—a retrospective cohort study

2021 ◽  
Author(s):  
David Krus ◽  
Fredrik Kahn ◽  
Bo Nilson ◽  
Torgny Sunnerhagen ◽  
Magnus Rasmussen
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Culture Time ◽  
Time To Positivity

AbstractNon-β-hemolytic streptococci (NBHS) cause infective endocarditis (IE) and a short blood culture time to positivity (TTP) is associated with risk of IE in bacteremia with other pathogens. In this retrospective population-based cohort study, we investigate if TTP is associated to IE or mortality. Of 263 episodes with NBHS bacteremia, 28 represented IE and the median TTP did not differ significantly between episodes with IE (15 h) and non-IE (15 h) (p=0.51). TTP was similar among those who survived and those who died within 30 days. However, TTP significantly differed when comparing the different streptococcal groups (p<0.001).

Infective endocarditis and its complications

2021 ◽  
Vol 2 ◽  
pp. 62-67
Author(s):  
Elizaveta Kiseleva ◽  
◽  
Evgeny Kozlitin ◽  
Alexey Kalyagin ◽  
Natalya Balabina ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Drug Addiction ◽  
Clinical Picture ◽  
Clinical Observation ◽  
Intravenous Drug ◽  
Aortic Valves ◽  
Etiological Factors

The article presents a clinical observation of infective endocarditis of the tricuspid and aortic valves in a patient suffering from intravenous drug addiction. A feature of this observation is the developed multiple complications — ischemic stroke, pneumonia, spleen infarction. The diagnosis of infective endocarditis became possible after the appearance of the clinical picture of ischemic stroke. Clinical observation demonstrates the need to take into account all possible etiological factors in the event of a picture of ischemic stroke in the process of diagnosis.

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