Abstract: FR-PO914
Immunosuppressant Use in Infective Endocarditis-Associated Glomerulonephritis: A Systematic Review
Session Information
- Glomerular Diseases: Potpourri
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Aly, Mostafa Gaafar, Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt
- Sayad, Reem, Assiut University Faculty of Medicine, Assiut, Assiut, Egypt
- Sherif, Leenah Nasser, Emergency Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
- Mokresh, Muhammed Edib, Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Turkey
- Mohamed Shawqi, Mohamed, Emergency Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
- Mohammed, Yasmine Adel, Assiut University Faculty of Medicine, Assiut, Assiut, Egypt
- Hawash, Eslam Anwar, Benha University Faculty of Medicine, Benha, Egypt
- Ali, Ahmed Mostafa, Assiut University Faculty of Medicine, Assiut, Assiut, Egypt
- Elsaeidy, Ahmed Saad, Benha University Faculty of Medicine, Benha, Egypt
Background
Patients with infective endocarditis (IE) can develop various renal diseases, including infection-related glomerulonephritis (GN). Antibiotics are essential for eradicating the infection. However, the prognosis for renal function remains poor. The use of immunosuppressants in IE-associated GN is still debated. This systematic review examines the role of immunosuppressants in managing these cases.
Methods
A comprehensive search was performed across four databases: PubMed, Scopus, MedLine, and Web of Science up to April 2024. We included studies that investigated patients with any type of GN due to IE who were treated with immunosuppressants. Data extraction was conducted using a standardized sheet, and study quality was assessed using the JBI critical appraisal tool.
Results
The review incorporated 55 studies encompassing 84 cases, 65 of whom were male. The median age was 46.5 years. Predisposing factors and cardiac and renal manifestations are detailed in Figure 1. Immunosuppressants used included steroids (oral and/or IV), cyclophosphamide, rituximab, azathioprine, mycophenolate mofetil, and hydroxychloroquine. Thirty cases required dialysis. Following immunosuppressive therapy, 69 cases improved, 10 worsened, and 5 showed no improvement in renal function. There were 10 fatalities, with 4 cases due to sepsis, 3 due to congestive heart failure, 1 due to cardiac arrhythmia, 1 due to renal failure, and 1 due to an unreported cause. Additional treatments included plasma exchange, with 9 cases receiving plasmapheresis/plasma exchange. Of these, 8 patients showed marked renal function improvement, and 1 patient showed partial improvement. Three patients also received IVIG.
Conclusion
Immunosuppressive therapy led to renal function improvement in the majority of cases, suggesting its potential benefit in managing IE-related GN. However, variability in response and significant mortality highlight the need for individualized treatment strategies and further research to optimize management.
Legend
Figure 1: PRISMA Flowchart for the selection of studies and an algorithm summarizing the included cases.