血行性腎孟腎炎による急性腎不全で発症した感染性心内膜炎の1例

Abstract

We report a case of infective endocarditis (IE) with acute renal failure. A 30-year-old man who had undergone right nephrectomy due to a traffic accident was admitted to our hospital because of fever and oliguria. He had suffered from an infected nail on a right toe two years bofore admission. Two weeks prior to admission, a high-grade fever, chills, and malaise developed, and the patient noticed many Osler's nodes on his hands and feet. Laboratory data on admission disclosed a marked increase in serum creatinine (7.6mg/dl) and leukocytosis with a left shift. An echocardiogram revealed a large vegetation on a posterior leaflet of the mitral valve, complicated by moderate mitral regurgitation. Cultures of blood and urine samples yielded Staphylococcus aureus. IE and acute renal failure were diagnosed. The patient received cephazolin (8g dialy) and underwent hemodialysis. Three days after admission, urine volume increased and hemodialysis was discontinued. The high fever disappeared one month later. A renal biopsy performed on the 50 th hospital day revealed interstitial nephritis accompanied by neutrophilic infiltration. Neither crescent nor mesangial proliferation was evident. This was an extremely rare case in which renal failure was probably caused by hematogenous pyelonephritis affecting the solitary kidney.