Embolic nephritis

Introduction Embolization nephritis is one of the renal manifestations of infective endocarditis in renal damage, including cardiovascular interventional and cardiac or non-cardiac surgery, intracardiac pressure monitoring intubation, atrioventricular shunt, high-energy nutrition, biopsy, pacing , arteriovenous cannula, catheter, tracheal intubation (especially in burn patients, when resistance is reduced). Bacteria or products thereof that cause infective endocarditis act as antigens, producing corresponding antibodies, which constitute a circulating immune complex. The deposition site of the immune complex in the glomerulus is related to the type of bacteria and the period of infection, but mainly depends on the size and solubility of the antigen-antibody complex.

Cause

Causes

The occurrence of infective endocarditis is related to the following factors:

1. Basic diseases: Patients with infective endocarditis often have underlying cardiovascular disease. Rheumatic heart disease accounts for 60% to 80% of the total number of cases, of which mitral valve (especially mitral valve prolapse) and aortic regurgitation are the most common, and tricuspid or pulmonary valve disease is less. Ventricular septal defect and patent ductus arteriosus are the most common in congenital heart disease, followed by bicuspid aortic valve, tetralogy of Fallot and rupture of aortic sinus aneurysm. Other diseases such as horse syndrome, syphilitic heart disease and hypertrophic cardiomyopathy can also be caused.

2. Pathogens: Acute infective endocarditis is mostly caused by invasive endocardium by highly toxic bacteria. Staphylococcus aureus infection is the main cause of acute infective endocarditis, and is also the main cause of drug and artificial valve patients. Pathogenic bacteria. These patients often have systemic bacterial spreads, including skin, bone, joints, eyes, and brain. 5% to 10% of patients with drug-induced and prosthetic valve infective endocarditis are caused by Gram-negative bacteria. Infective endocarditis caused by anaerobic infection accounts for about 1%, probably due to the high oxygen content in the heart, which is not conducive to the growth of anaerobic bacteria.

3. Immunological factors: Bacteria in endocardial neoplasms stimulate the immune system to produce non-specific antibodies, resulting in increased gamma globulin, rheumatoid factor-positive, and accidental syphilis serum test positive. Rheumatoid factor positive in more than half of patients with subacute infective endocarditis, provide clues to the diagnosis of this disease in blood culture negative patients, and turned negative after the bacteria were killed. Anti-endocardial and anti-muscle membrane antibodies are present in 60% to 100% of patients with infective endocarditis (especially subacute infective endocarditis).

an examination

Related inspection

Renal percussion concentration test urinary phosphorus renal angiography plasma osmotic examination

The clinical manifestations depend on the size of the embolus and the extent of the embolization. The small patients may have no symptoms, only microscopic hematuria or proteinuria; the larger one may suddenly have severe low back pain, similar to renal colic caused by kidney stones, often Gross hematuria appears. Should go to the regular hospital for nephrology examinations, such as liver function, ultrasound monitoring of the affected area, urine routine examinations.

Differential diagnosis

(1) Immune nephritis: Immune nephritis occurs more than a few weeks after the onset of endocarditis, in line with the mechanism of immune response, manifested as different degrees of microscopic or gross hematuria, proteinuria, red blood cell cast, light to medium Acute nephritis syndrome with azotemia is common, blood urea and creatinine are elevated, creatinine clearance is decreased, and there are reports of extensive crescent formation in the kidney, clinically rapid nephritis, and some patients may have hypoproteinemia. And renal edema, and nephrotic syndrome is rare, common extensive and severe kidney damage, renal failure can occur.

(2) tubulointerstitial nephritis: infective endocarditis causes interstitial nephritis and infection pathogens through the blood circulation into the renal parenchyma caused by interstitial nephritis and long-term use of a large number of antibiotics, the use of antibiotics, especially penicillins, can lead to allergic tubules Interstitial nephritis, its clinical manifestations are similar to other drug-related tubulointerstitial nephritis.

(3) renal abscess: acute staphylococcal endocarditis accompanied by systemic sepsis can also cause multiple small abscesses in the kidney, clinical manifestations of fever, low back pain, sputum pain in the kidney area, hematuria can occur.

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