A Case of Early Developed Secondary Renal Amyloidosis in a Patient with Rheumatoid Arthritis (RA).
- Author:
Sung Hun KIM
1
;
Ho Sick JANG
;
Chang Wook JEONG
;
Jae Young JANG
;
Seong CHO
;
Sung Rock KIM
;
Hwal Woong KIM
Author Information
1. Department of Internal Medicine, Masan Samsung Hospital, Sung Kyun Kwan University, College of Medicine, Masan, Korea. chaecho@samsung.co.kr
- Publication Type:Case Report
- Keywords:
Secondary renal amyloidosis;
Rheumatoid arthritis (RA)
- MeSH:
Albuminuria;
Amyloid;
Amyloidosis*;
Arthritis, Rheumatoid*;
Biopsy;
Cholesterol;
Colitis, Ulcerative;
Creatinine;
Diagnosis;
Edema;
Electrophoresis;
Hemiplegia;
Humans;
Hydrogen-Ion Concentration;
Mesalamine;
Methotrexate;
Microscopy, Polarization;
Middle Aged;
Neurology;
Physical Examination;
Plaque, Amyloid;
Prednisolone;
Proteinuria;
Serum Albumin;
Specific Gravity;
Urinalysis
- From:Korean Journal of Nephrology
2004;23(1):163-168
- CountryRepublic of Korea
- Language:Korean
-
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.
