Acute kidney injury in patients with prosthetic valve IE

Infective endocarditis (IE) is a serious disease with a high associated mortality rate, particularly when complicated by acute renal failure (ARF).In some cases, IE induces rapidly progressive glomerulonephritis and results in end-stage renal failure, which is associated with poor patient prognosis [1]. Patients with IE associated with ARF can be successfully treated with the proper use of antibiotics, surgery, renal replacement and ACEI/ARB therapies.Early detection of patients with impaired renal function may help to ensure more aggresive treatment and to improve clinical outcome. Serum creatinine is still gold standard of kidney injury, although it is well known as an insensitive and unreliable biomarker (for example, its concentration does not increase significantly until about half of the kidney function is lost). Considering these data, researches and clinicians are making great efforts in the past decade in order to discover and validate novel AKI biomarkers. Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin-18 (IL-18), Cystatin C (Cys-C) are some of new, promising markers of kidney damage which are currently in the focus ofpreclinical and clinical studies. Recent data suggest that some of these new biomarkers represent important parametars of acute tubular necrosis (ATN) and reliable predictors of development and prognosis of AKI. Beside that, monitoring of these markers could have significant importance for early d

Клинический случай острого миокардита у пациента после протезирования митрального клапана по поводу активного инфекционного эндокардита

The article describes a clinical case of a 69-year-old patient with subacute infectious endocarditis caused by Staphylococcus haemolyticus. After implantation of prosthetic mitral valve, the mechanical prosthesis developed acute myocarditis with rapid progression of heart failure. The contribution of immune mechanisms and viral infection to the development of myocarditis in a patient after cardiac surgery and the possibility of treatment with human immunoglobulin are discussed in the article.Представлен клинический случай 69-летнего пациента с подострым инфекционным эндокардитом, вызванным Staphylococcus haemolyticus, у которого после протезирования митрального клапана механическим протезом развился миокардит с быстрым прогрессированием сердечной недостаточности. В статье обсуждается вклад иммунных механизмов и вирусной инфекции в развитие миокардита у пациента после кардиохирургической операции, возможности лечения человеческим иммуноглобулином

Клинический случай острого миокардита у пациента после протезирования митрального клапана по поводу активного инфекционного эндокардита

The article describes a clinical case of a 69-year-old patient with subacute infectious endocarditis caused by Staphylococcus haemolyticus. After implantation of prosthetic mitral valve, the mechanical prosthesis developed acute myocarditis with rapid progression of heart failure. The contribution of immune mechanisms and viral infection to the development of myocarditis in a patient after cardiac surgery and the possibility of treatment with human immunoglobulin are discussed in the article.Представлен клинический случай 69-летнего пациента с подострым инфекционным эндокардитом, вызванным Staphylococcus haemolyticus, у которого после протезирования митрального клапана механическим протезом развился миокардит с быстрым прогрессированием сердечной недостаточности. В статье обсуждается вклад иммунных механизмов и вирусной инфекции в развитие миокардита у пациента после кардиохирургической операции, возможности лечения человеческим иммуноглобулином

Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

Background Coagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. In this study we aimed to assess the coagulation and platelet state in IE implementing a wide range of standard and global laboratory assays. We also aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients. Methods 37 patients with IE were enrolled into the study. Coagulation was assessed using standard coagulation assays (activated partial thromboplastin time (APTT), prothrombin, fibrinogen, D-dimer concentrations) and integral assays (thromboelastography (TEG) and thrombodynamics (TD)). Platelet functional activity was estimated by flow cytometry. Single nuclear polymorphisms of coagulation system genes were studied. Results Fibrinogen concentration and fibrinogen-dependent parameters of TEG and TD were increased in patients indicating systemic inflammation. In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation. However, in some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation. Resting platelets were characterized by glycoprotein IIb-IIIa activation and degranulation. In patients with fatal IE, we observed a significant decrease in fibrinogen and thrombodynamics. In patients with embolism, we observed a significant decrease in the TEG R parameter. No association of embolism or mortality with genetic polymorphisms was found in our cohort. Conclusions Our findings suggest that coagulation in patients with infective endocarditis is characterized by general hypercoagulability and platelet pre-activation. Some patients, however, have hypocoagulant coagulation profile, which presumably can indicate progressing of hypercoagulation into consumption coagulopathy. © 2021 Koltsova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited