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Dilation and blunting of the renal calyces with cortical thinning
4%
12/287
Immune complex deposition
48%
137/287
Vascular damage to renal vessels secondary to benign nephrosclerosis
14%
39/287
Hereditary nephritis caused by a mutation in glomerular basement membrane
5%
13/287
Renal papillary necrosis secondary to infarctions of the medulla
21%
60/287
Select Answer to see Preferred Response
This patient is an IV drug user who presents with infectious endocarditis and subsequently developed glomerulonephritis caused by immune complex deposition. Intravenous drug users are more likely to present with infectious endocarditis as a result of Staphylococcus aureus. This patient presents with tricuspid regurgitation and later develops acute renal insufficiency with glomerulonephritis. Suspect bacterial endocarditis in a young patient with new-onset fatigue and a heart murmur. Staphylococcus-associated glomerulonephritis involves glomerular deposition of preformed circulating immune complexes, much like post-streptococcal glomerulonephritis. It has been hypothesized that in situ immune complex formation may occur due to staphylococcal antigens planted in the glomeruli. Pierce et al. describe the diagnosis and management of infective endocarditis. Risk factors include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. Endocarditis should be suspected in patients with unexplained fevers, night sweats, or signs of systemic illness. Nasr et al. discuss bacterial infection-related glomerulonephritis in adults and note that the sites of infection in adult infection-related glomerulonephritis are more heterogeneous than in children, and include the upper respiratory tract, skin, lung, heart, urinary tract, teeth/oral mucosa, and bone. Figure A shows track marks, a sign of IV drug use. Incorrect Answers: Answer 1: Dilation and blunting of the renal calyces with cortical thinning is characteristic of chronic pyelonephritis. Answer 3: Vascular damage to renal vessels secondary to benign nephrosclerosis is seen in malignant hypertension. Answer 4: Mutations in the glomerular basement membrane are found in Alport's disease. Answer 5: Renal papillary necrosis may occur in sickle cell nephropathy.
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