Infective endocarditis associated with acute renal failure: Repeat renal biopsy and successful recovery

Area of Science:

• Cardiology
• Nephrology
• Infectious Diseases

Background:

• Infective endocarditis (IE) presents significant mortality risks, especially when complicated by acute renal failure (ARF).
• Optimal therapeutic strategies for IE with ARF, including surgical interventions and antibiotic regimens, require further elucidation.

Purpose of the Study:

• To report a rare case of IE in a young male with a history of intravenous drug abuse presenting with ARF.
• To describe the management and outcomes of a complex IE case involving tricuspid valve replacement and subsequent renal dysfunction.

Main Methods:

• Initial treatment included antibiotics, hemodialysis, and anticoagulants, followed by tricuspid valve replacement surgery.
• Management of post-operative ARF involved continuous ambulatory peritoneal dialysis and pharmacotherapy with ACE inhibitors and ARBs.
• Two renal biopsies were performed to assess pathological changes and treatment efficacy.

Main Results:

• The patient developed ARF post-surgery, with initial biopsy revealing type II crescentic glomerulonephritis.
• Following peritoneal dialysis and pharmacotherapy, significant improvement in renal function was observed, confirmed by a second biopsy showing resolution of crescentic glomerulonephritis.
• Complete renal function recovery was achieved 12 weeks after therapy initiation.

Conclusions:

• Eradication of infection, tricuspid valve replacement, and renal substitution therapy can lead to successful recovery in select IE patients with ARF.
• This case underscores the importance of a multidisciplinary approach in managing complex IE cases with renal complications.