Glomerular Disease in Patients with Infectious Processes Developing Antineutrophil Cytoplasmic Antibodies

Abstract

To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics.

Renal Disease in Patients with Infective Endocarditis and Antineutrophil Cytoplasmic Antibodies

“…The development of ANCA during the course of infective endocarditis is associated with multiple other serological abnormalities and with some clinical manifestations typically associated with ANCA. Currently there is no agreement about the effect of ANCA formation on the severity of post-infectious glomerulonephritis [80,102], and more importantly, no specific ANCA findings pointing towards the diagnosis of pauci-immune glomerulonephritis versus other renal histology have been reported [36,61]. The definitive diagnosis of the type of renal disease in a patient with endocarditis, multiple autoantibodies, and urinary findings suggesting glomerulonephritis requires performance of kidney biopsy.…”

“…A second major category of differential diagnosis is between infectious endocarditis and other conditions causing ANCA antibody formation. These conditions, the list of which is increasing, include other chronic infections [61], drugs including hydralazine, propylthiuracil, penicillamine, allopurinol, sulfasalazine [62], minocycline, procainamide, carbimazole, thiamazole, clozapine, phenytoin, and others, chronic inflammatory conditions, including systemic lupus erythematosus, rheumatoid arthritis [63], inflammatory bowel disease, primary sclerosing cholangitis, autoimmune hepatitis [64] and others, and various malignancies [65].…”

Crescentic Glomerulonephritis with Tubercular Lymphadenitis

“…Renal limited crescentic glomerulonephritis is a small subset of such patients which may or may not be ANCA positive. The presence of simultaneous active infection in the presence of ANCA mediated crescentic glomerulonephritis is rare and constitutes a thereupatic challenge [1,2]. We describe a case of Tubercular Lymphadenitis with ANCA positive crescentic glomerulonephritis presenting simultaneously which was successfully managed with a good clinical outcome [1,2].…”

“…Of the fifty cases reported in literature, more than half are in patients with infective endocarditis, predominantly presenting as immune complex mediated glomerulonephritis. The microbiological diagnosis in two thirds of the cases, are from gram positive cocci, like Staphylococci, Streptococci and Enterococcus species; while Mycobacterium tuberculosis infection has been rarely reported [1]. Tuberculosis itself can cause renal disease in a number of ways.…”

Infected Aortic Aneurysm Mimicking Anti-proteinase 3-Antineutrophil Cytoplasmic Antibody-associated Vasculitis

“…Several infections, particularly infective endocarditis, have been reported to show positive findings on ANCA tests; furthermore, their clinical features have been acknowledged to mimic ANCA-associated vasculitis, which may lead to a misdiagnosis and inappropriate treatment (2,3). However, to our knowledge, infected aortic aneurysms have not been reported to show positive findings on ANCA tests.…”