Abstract
It is thought that the renal disease which sometimes accompanies bacterial endocarditis is due to antigen-antibody complex mechanisms because of the demonstration of immunoglobulin and complement in histologic specimens; however, the specificity of the antibody is not known. We have attempted to further define the pathogenetic mechanism by elution of kidney-bound protein and investigation of its properties. A patient with no previous renal disease who died of bacterial endocarditis and renal failure was studied. He presented with bacterial endocarditis accompanied by elevations of serum immunoglobulins and ultimately developed a monoclonal IgM. Light microscope examination of the kidney revealed segmental nephritis; fluorescent staining showed deposits of the 3 major classes of immunoglobulins and complement along the glomerular basement membrane (GBM) in a “lumpy-bumpy” distribution. Protein was eluted from the post-mortem kidney and radiolabeled with I125. Radioautographic studies showed the presence of IgG and IgA. The eluted antibody was shown to selectively combine with bacteria (formalin fixed) cultured from the patient ante-mortem. There was also evidence for anti-GBM antibody activity of the eluate. The eluted antibody was not anti-antibody (i.e. did not selectively combine with IgG coated human red blood cells). The demonstration in the kidney eluate of antibacterial antibody specific for the organism cultured from the patient strongly supports the concept of antigen-antibody complex disease in the patho-genesis of the nephritis which accompanies SBE.
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Levy, R., Hong, R. Nature of kidney-bound antibody in the renal disease of bacterial endocarditis. Pediatr Res 5, 385 (1971). https://doi.org/10.1203/00006450-197108000-00061
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DOI: https://doi.org/10.1203/00006450-197108000-00061