Subject(s)
Paraproteinemias/complications , Thrombotic Microangiopathies/etiology , Acute Kidney Injury/etiology , Aged , Combined Modality Therapy , Female , Humans , Immunosuppressive Agents/therapeutic use , Kidney Glomerulus/pathology , Male , Middle Aged , Multiple Myeloma/complications , Multiple Organ Failure/etiology , Plasma Exchange , Recurrence , Thrombotic Microangiopathies/pathology , Thrombotic Microangiopathies/therapy , Waldenstrom Macroglobulinemia/complicationsABSTRACT
A 67-year-old man was evaluated for haematuria, with a rising creatinine level from 88 to 906 µmol/L and positive c-anti-neutrophil cytoplasm antibody (ANCA)/anti-proteinase 3 (anti-PR3). A kidney biopsy revealed necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy. Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis. Dialysis was required for a month. Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared. This first case of c-ANCA/anti-PR3 positive glomerulonephritis with a 'full-house' immunofluorescence pattern due to bacterial endocarditis underlines the importance of ruling out infection with ANCA positivity or kidney biopsy suggestive of lupus nephritis.