BACTERIAL-ENDOCARDITIS ASSOCIATED WITH CRESCENTIC GLOMERULONEPHRITIS IN A KIDNEY-TRANSPLANT PATIENT

Background. Endocarditis-induced crescentic glomerulonephritis is a we ll-described complication in nontransplant patients. Its occurrence in transplant patients has not been reported to date. Methods. A 50-year -old man who had received a renal allograft 13 years before and been t reated with prednisone, 10 mg/day, was admitted for progressive renal failure, purpura, edema of the lower limbs, and fever. Results. Blood cultures isolated Streptococcus bovis and cardiac ultrasound examinati on revealed a 23-mm-large vegetation on the mitral valve. His plasma c reatinine level was 478 mu mol/L and his proteinuria was 5.5 g/day. A renal biopsy showed diffuse crescentic glomerulonephritis. Long-term a ntibiotic treatment and three methylprednisolone pulses were effective in treating the endocarditis and glomerulonephritis. Conclusion. Endo carditis-induced glomerulonephritis is an immune-mediated disease that can also occur on a renal allograft. It is likely that a low daily do se of immunosuppressive treatment may have been a facilitating factor.