Abstract

RODRIGUEZ, Esmeralda Castillo et al. Rapidly progressive glomerulonephritis associated to afebrile endocarditis and anti-proteinasa 3 anca. Rev. colom. nefrol. [online]. 2017, vol.4, n.1, pp.85-92. ISSN 2500-5006.  https://doi.org/10.22265/acnef.4.1.258.

Endocarditis associated with antiPR3 ANCA and acute kidney injure generates a challenge in its diagnosis and treatment. In order to make a review about that combination, we presented a patient with necrotizing glomerulonephritis produced by a Enterococcus faecalis's subacute endocarditis and antiPR3 ANCA positive.

Differential diagnosis is made between an acute kidney failure produced by ANCA's vasculitis vs necrotizing glomerulonephritis by endocarditis. Frequently it is necessary to make a biopsy to get a diagnosis. Negative immunofluorescence will guide to vasculitis associated ANCA, while positive immune complexes will guide to poststreptococcal glomerulonephritis.

Other challenge that generates the association of acute kidney disease, endocarditis and antiPR3 ANCA is the treatment. ANCA positive can prompt to start immunosuppressant treatments. However, in the context of endocarditis, it could be inadvisable and even dangerous to use it. For this reason, it is controversial the use of immunosuppressant in combination with antibiotics in the acute process, in contrast with the use of only antibiotics. In the current paper we collect the 19 reports in the literature about endocarditis associated with antiPR3 ANCA, the treatment and the renal evolution of each patient. We concluded, generally, a better improvement of kidney function in patients treated with only antibiotics than those patients treated with the combination of antibiotics and corticoids. However, there are so few reports that we can't consider significant the different between both treatment groups.

Keywords : ANCA antiPR3; postinfectious/poststreptococcal glomerulonephritis; endocarditis; necrotizing glomerulonephritis.

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