Keywords: infective endocarditis kidney damage

    Outline

    Variety of pathogens (bacteria and also viruses, mycoplasma, protozoa, etc.) into the blood with blood reflux the Zhixin chamber, growth and reproduction of the heart lining caused by endocardial damage and release toxins, the body from fever and the patient felt heart palpitations and other discomfort. Its cause kidney damage mainly two kinds: (1) autoimmune nephritis; (2) embolic nephritis (renal infarction); The disease can occur in any region, any season, any crowd, but more common in rheumatic heart disease and congenital heart disease patients. Despite the severe glomerular damage even massive proteinuria, but early diagnosis and timely use of appropriate antibiotics, most of the disease can be cured, such as delays in diagnosis and treatment may be due to heart failure, life-threatening or cause kidney failure

    Clinical manifestations

    An irregular fever. 2. Edema. Conjunctiva, oral mucosa, as well as the chest skin bleeding point. 4. Hematuria, microscopic hematuria, can also be seen gross hematuria. 5 conducted anemia. The 6. Visceral embolization performance. 7 new heart murmur or the original heart murmur changed. 8 individual can occur in patients with acute renal failure. Performance oliguria, anuria, etc..

    Diagnosis is based on

    1. Fever. 2 skin, mucous membrane bleeding point. 3. Anemia. 4 heart murmur changed. 5. Proteinuria, hematuria. Blood culture bacteria positive. 7 echocardiography prompted endocardial vegetations.

        Principles of treatment

    Treated with antibiotics (penicillin preferred); principle of the use of antimicrobials for the medication earlier; selection of bactericidal drugs; dose should be sufficient; longer course of treatment. Symptomatic and supportive treatment. Anti-heart failure treatment. Antiarrhythmic therapy. 5. Acute renal failure, blood purification treatment such as hemodialysis. Necessary line of heart valve replacement surgery.

        The principle of a drug

    . Viridans streptococci, enterococci infection, the first use of penicillin; ineffective or poor efficacy, the choice of cephalosporin thiophene; those who are allergic to cephalosporins, switch to vancomycin; 2. Suspected Staphylococcus aureus selection of the new penicillin II, ethoxycarbonyl penicillin; switch to cephalosporins of the new penicillin allergy or invalid; still allergic or ineffective, switch to vancomycin; suspected Staphylococcus epidermidis infections, the choice of rifampicin; choice of enterococcal infections ammonia the Bian benzyl penicillin, cephalosporin sulfur meters; those who are allergic to switch to vancomycin; 5. Pioneer will be selected gram-negative bacilli infections, the cephalosporin plug oxime sodium Pan, ceftriaxone; may also be to use ammonia Bian benzyl penicillin; 6. infection control and severe cases of heart valve disease, may consider surgical valve replacement; 7. uremic may be blood purification therapy; 8 after treatment, endocarditis controlled, nephritis symptoms do not improve, plus adrenal corticosteroids; 9. treatment with Chinese medicine.
     
    Auxiliary examination

    Limit inspection to check the box “A" typical patient-based; 2. Difficulties or need to look for further according to differential diagnosis, can be used for checking the check box to limit the “B"; 3. Need to know points renal function or pathological conditions, and can be used for the “C" check box to limit items check.

    Evaluation

    Cure: the symptoms disappeared, anemia improve urine examination was normal, with normal renal function; improvement: improvement of symptoms, anemia improved urinary protein positive + + The following quantitative for ≥ 1g/24 hours. Normal renal function; 3. Healed: no improvement in signs and symptoms, more urine protein and kidney function is not normal.