Korean J Nephrol.  2004 Jan;23(1):163-168.

A Case of Early Developed Secondary Renal Amyloidosis in a Patient with Rheumatoid Arthritis (RA)

• Kim SH
• Jang HS
• Jeong CW
• Jang JY
• Cho S
• Kim SR
• Kim HW

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.

Keyword

Secondary renal amyloidosis; Rheumatoid arthritis (RA)

MeSH Terms

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
Amyloid
Cholesterol
Creatinine
Mesalamine
Methotrexate
Prednisolone
Serum Albumin