Long-Term Follow-up Study of Penicillin-Treated Subacute Bacterial Endocarditis

Infective Endocarditis Developing as Uremia

“…In the pre-antibiotic era, renal failure was clinically present in 25 to 35 percent of patients IE and some form of nephritis was shown in 80 percent at autopsy, however, the introduction of antibiotic therapy has greatly reduced the renal complications of IE, particularly renal failure (1,5,6). Renal dysfunction is still thought to be one of the complications of IE, but renal failure necessitating hemodialysis is not generally recognized as a complication of IE.…”

Renal Complications of Bacterial Endocarditis

“…The incidence of renal insufficiency in endocarditis has diminished since the advent of effec tive antibiotic therapy, as has the percent of those dying of end-stage renal failure. Azotemia was reported in 20-75% of patients in the preatibiotic period [28][29][30][31], but in only 10-33% of patients in the postantibiotic period [28,32]. Similarly, some 15-25% of deaths in endocarditis were accompanied by uremia before antibiotics [33,34], whereas less than 5% now die with uremia [27,35,36].…”

“…33,37]. Antibiotics have resulted in a decrease in the incidence of focal glomerulonephritis to 18-25% [28,33,34], The lesion is less common in cases of acute bacterial endocarditis, where the reported range is less than 15% [37,41,42], and is rare in cases of right-sided endocardi tis [17,40], Focal glomerular lesions frequently occur along the edges of renal infarcts ( fig. 4), while the major ity of adjacent glomeruli are totally spared [38].…”

Diseases of the Urinary System

“…The pathological renal lesions associated with subacute bacterial endocarditis are highly variable, ranging from predominant embolic destruction of the kidney to a glomerulo nephritis, with a poor correlation between the extent of the lesion on histo logical examination and the renal insufficiency which is evident clinically. The importance of early treatment is emphasized by Gorlin, Favour & Emery (117). They find that the incidence of renal lesions has been greatly reduced by penicillin treatment and that in certain cases the renal lesion healed.…”