Successful Treatment of Infectious Endocarditis Associated Glomerulonephritis Mimicking C3 Glomerulonephritis in a Case with No Previous Cardiac Disease

We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE

Short-term impact of switching from erythropoiesis-stimulating agents and roxadustat to daprodustat among patients undergoing hemodialysis

Abstract Daprodustat is a novel oral agent for renal anemia. This retrospective study examined 124 maintenance patients undergoing HD who had shifted from erythropoiesis-stimulating agents (ESA) or roxadustat to daprodustat (4mg daily). Anemia control, iron metabolism markers, and doses of daprodustat within 3 months after the shifting therapies were assessed. We used multivariate logistic regression analysis to determine the factors associated with the use of high doses of daprodustat 3 months after. The serum hemoglobin level significantly decreased after shifting therapies. Similarly, the proportion of patients who achieving a hemoglobin level within the appropriate range was also significantly lower, and median doses of daprodustat gradually increased. A significant increase in the serum iron, total iron-binding capacity, and transferrin saturation levels were found, but the serum ferritin level did not differ during the study period. Multivariate regression analysis showed that diabetes, a low Hb level, and use of high doses of ESA/roxadustat were independent predictors for the use of high doses of daprodustat 3 months after shifting therapies. We concluded that renal anemia control may worsen after shifting to daprodustat. Patients with diabetes, a low Hb level at baseline, and those receiving high doses of ESA/roxadustat may require high doses of daprodustat.</jats:p