ABSTRACT
We experienced a case of secondary renal amyloidosis diagnosed by renal biopsy in a patient who had been diagnosed as RA two years ago. A 62-year old man was admitted to neurology departement because of right hemiplegia. During conservative care at neurology department, he was consulted to us because of aggravated generalized edema and proteinuria. He was diagnosed as rheumatoid arthritis and ulcerative colitis two years ago, and then he had taken prednisolone, methotrexate, mesalazine regularly. At physical examination, there was no abnormal finding except pretibial pitting edema and right hemiplegia. In urinalysis, specific gravity was 1.025, pH was 5.5, protein was 4+ and RBC 0-1/ HPF and WBC 0-1/HPF. Total protein of 24 hour's urine was 5.5 g/day. The blood BUN and creatinine level were 16.4 mg/dL, 0.4 mg/dL and cholesterol level were 154 mg/dL, total protein and albumin were 4.4 g/dL and 1.9 g/dL. Serum RA factor and CRP showed high level as 94.90 IU/mL and 118.00 mg/L. On urine electrophoresis, albuminuria was dominant but M-spike was not founded. On urinalysis taken at the time of first diagnosis of rheumatoid arthritis two years ago, proteinuria was negative and serum albumin levels was 3.6 g/dL. At that time, there was no evidence of nephropathy. In renal biopsy, electron microscope showed heavy nonbranching amyloid fibrils accumulated in mesangium and polarized light microscopy after Congo-red staining revealed apple-green birefringent amyloid deposits in glomeruli and blood. So we diagnosed renal amyloidosis associated with RA.
Subject(s)
Humans , Middle Aged , Albuminuria , Amyloid , Amyloidosis , Arthritis, Rheumatoid , Biopsy , Cholesterol , Colitis, Ulcerative , Creatinine , Diagnosis , Edema , Electrophoresis , Hemiplegia , Hydrogen-Ion Concentration , Mesalamine , Methotrexate , Microscopy, Polarization , Neurology , Physical Examination , Plaque, Amyloid , Prednisolone , Proteinuria , Serum Albumin , Specific Gravity , UrinalysisABSTRACT
Amyloidosis comprises a diverse group of systemic and local diseases characterized by organ involvement by the extracellular deposition of fibrils composed of subunits of a variety of normal serum proteins. Secondary amyloidosis is caused by the deposition of amyloid A(AA) protein in chronic inflammatory disease. Juvenile rheumatoid arthritis(JRA) has been known to be the most common cause of secondary amyloidosis. We experienced one case of secondary renal amyloidosis in a 12-year-old girl who had suffered from JRA for several years who had visited our renal clinic to evaluate the proteinuria with microscopic hematuria which was detected by chance at school urine screening examination. Apple green birefringence was observed under polarized light with Congo red stain and characteristic electron microscopic findings was also noted in renal tissues which was obtained by percutaneous renal biopsy. In our knowledge, this is the first case report of secondary renal amyloidosis developed in pediatric age in Korea.
Subject(s)
Child , Female , Humans , Amyloid , Amyloidosis , Arthritis, Juvenile , Biopsy , Birefringence , Blood Proteins , Congo Red , Hematuria , Korea , Mass Screening , ProteinuriaABSTRACT
The authors report a case of secondary renal amyloidosis associated with rheumatoid arthritis, which responded well to Kampo therapy. A 68-year-old woman was diagnosed as having rheumatoid arthritis in April 1992. Her disease activity was not controlled well with any anti-rheumatic drugs. In September 1996, proteinuria and hematuria were found, and a renal biopsy showed secondary amyloidosis. Proteinuria and hematuria were progressive. The patient was treated with Sairei-to, and by April 1998, proteinuria and hematuria nearly disappeared. This clinical course suggests that Sairei-to is an effective treatment for secondary renal amyloidosis.