Chronic interstitial nephritis in Whipple's disease.

Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia. Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsies disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease was made. Shortly before death, diarrhea developed. Autopsy revealed a massive systemic involvement in Whipple's disease proven by light and electron microscopy and immunofluorescence. Tuberculoid and epitheloid cell granulomas and isolated giant cells were found in addition to the biopsy findings in skeleton muscles, the small intestine, lymphnodes and bronchi. At autopsy, the kidney showed chronic interstitial nephritis. The literature of kidney involvement in Whipple's disease is reviewed. This is the first case with granulomatous interstitial nephritis and chronic renal insufficiency in an inadequately treated Whipple's disease.

[Procedure on finding microhematuria in medical practice]. / Vorgehen beim Befund einer Mikrohämaturie in der Praxis

Of 2000 unselected patients consecutively examined during the first 3 months of 1972 at the Outpatient Clinic for Internal Medicine, University of Basel, 102 (5.1%) were found to have pathologic erythrocyturia on routine urinalysis. In 63 of these patients the first examination did not produce a precise diagnosis such as to explain the microhematuria symptom. 30 of the 63 patients were not rechecked. 24 of the 33 rechecked patients with microhematuria again showed a pathologic erythrocyte count in urinalysis. Further workup for hematuria in 18 of these patients produced a definite diagnosis in 11 but not in the other 7 i.e. the final diagnosis in the latter was (microhematuria of undetermined origin). Workup for microhematuria is of great importance in clinical practice, and for this reason a specific procedure for workup of ambulatory patients is proposed.