关键词: 急性肾损伤, 心内膜炎, 手术, 肾疾病

Abstract: Objective To analyze the clinical features and prognosis of patients with infective endocarditis (IE) and acute kidney injury (AKI), and evaluate the effect of timely operation on prognosis of renal function. Methods Clinical data of 45 cases of IE and AKI who were admitted in Peking Union Medical College Hospital from January 2010 to May 2016 were retrospectively reviewed; among them 8 cases underwent renal biopsy and the pathologies were analyzed. Patients were divided into Operation group (22 cases) and Non-operation group (23 cases), and the clinical data and prognosis were compared. Results The ratio of male to female was 2.46: 1 and the average age was 48.3±16.6. 35.6% of cases were detected with basic valve diseases and the congenital valve diseases were the most common type. The most frequently infected valves were mitral valve (46.7%), aortic valve (28.9%) and prosthetic valve (8.9%) ordinally. The most common pathogenic bacteria were streptococcus (46.7%) and staphylococcus (35.6%). Some rare and special pathogen could also be found in these cases. In 8 cases underwent renal biopsy, 3 cases were diagnosed as crescentic nephritis, 2 cases were diagnosed as focal proliferative glomerulonephritis and mesangial proliferative glomerulonephritis respectively, 1 case was diagnosed as acute interstitial nephritis. C3 sedimentation was the most common phenomenon found in immunofluorescence. There was no significant difference between the baseline data of Operation and Non-operation groups, and neither was the survival rate. However, renal function recovered better in Operation group (P<0.05): the serum creatinine declined remarkably in 7 days (P＜0.05) and 30 days (P＜0.01)post operation, compared with the peak valve before operation. Conclusions The background valve diseases and pathogen have been changed in IE compared with traditional description. Crescentic nephritis is not rare in renal pathologic manifestation when parenchymal lesion is developed after the onset of IE. Timely operation can improve the renal prognosis in patients with IE and AKI.

Key words: Acute kidney injury, infective endocarditis, operation, kidney disease