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Two Cases of Proteinase 3-Anti-Neutrophil Cytoplasmic Antibody (PR3-ANCA)-related Nephritis in Infectious

Kazuya Hirai1, Naoto Miura, Masabumi Yoshino

  • 1Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan.

Internal Medicine (Tokyo, Japan)
|December 2, 2016
PubMed

Insights

Infectious endocarditis can cause kidney damage (nephritis) linked to proteinase 3-anti-neutrophil cytoplasmic antibodies (PR3-ANCA). Treatment involving surgery and antibiotics improved patient kidney function and PR3-ANCA levels.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Cardiology

Background:

  • Proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis can affect the kidneys.
  • Infectious endocarditis is a serious infection of the heart valves, often associated with bacteremia.

Observation:

  • Two middle-aged men presented with clinical and laboratory findings suggestive of PR3-ANCA-related nephritis.
  • Both patients had concurrent infectious endocarditis caused by Enterococcus faecium and Streptococcus bovis, respectively.
  • Clinical manifestations included proteinuria, hematuria, hypoalbuminemia, reduced kidney function, anemia, elevated CRP, and PR3-ANCA positivity.

Findings:

  • Surgical intervention for valvular pathology (aortic and tricuspid valve replacement) was performed.
  • Antibiotic therapy was administered for bacteremia.
  • Following treatment, both patients showed improvement in urinary abnormalities and PR3-ANCA titers at 6 months, without steroid use.

Implications:

  • This suggests a potential link between infectious endocarditis and PR3-ANCA-related nephritis.
  • Successful management of infectious endocarditis through surgery and antibiotics may lead to remission of associated kidney disease.
  • Further research is warranted to elucidate the pathogenic mechanisms and optimal treatment strategies for this condition.

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