INFECTIVE ENDOCARDITIS ASSOCIATED CRESCENTIC GLOMERULONEPHRITIS -SUCCESSFUL RECOVERY WITH STEROID THERAPY

Infection related glomerulonephritis (IRGN) contributes to significant morbidity in patients with infective endocarditis. Ideal treatment strategy has not been clearly defined because a prospective analysis of large cohort of patients has never been conducted and most of the information available were limited to retrospective studies and case reports. Unlike post infectious glomerulonephritis, the mainstay of therapy in patients with IRGN includes antibiotics, because infection is active in IRGN. The role of steroids and other immunosuppressants cannot be underestimated. There are several anecdotal reports supporting the use of immunosuppressants in IRGN. But, it still remains a therapeutic dilemma. We report a 26 year old gentleman who presented to us with fever, oliguria and severe renal failure. Echocardiogram revealed vegetations in mitral valve. Blood culture grew methicillin resistant Staphylococcus aureus(MRSA). Renal biopsy was consistent with crescentic glomerulonephritis. His blood cultures became sterile after 10 days of appropriate antibiotic therapy. He remained dialysis dependent despite continuation of antibiotics. He was started on pulse methyl prednisolone for three days followed by oral steroids. Following the pulse therapy, urine output increased and serum creatinine declined. Hence in selected patients particularly those who present with crescentic glomerulonephritis, steroid therapy may be beneficial when judiciously used along with antibiotics.