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Membranoproliferative glomerulonephritis and Pott's disease.

Ram R, Sandeep P, Sridhar AV, Rukumangadha N, Sivakumar V - Clin Kidney J (2014)

Bottom Line: The MRI of thoraco-lumbo-sacral spine revealed paravertebral abscess at D11-D12.He was started on anti-tuberculous medication.After 8 weeks of therapy, the serum creatinine was 1.5 mg/dL and 24 h urine protein 250 mg.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Sri Venkateswara Institute of Medical Sciences , Tirupati 500083 , India.

ABSTRACT
The reports of glomerular lesions of kidney due to tuberculosis are sparse. A 48-year-old gentleman, presented with swelling of feet of 3 months duration. As he had renal impairment, proteinuria and normal-sized kidneys, he was subjected to renal biopsy. The light microscopy and immunofluorescence revealed the diagnosis was membrano-proliferative glomerulonephritis. During hospital stay, the patient complained fever and stiffness at thoracic spine. The MRI of thoraco-lumbo-sacral spine revealed paravertebral abscess at D11-D12. The pus aspirated was positive for Mycobacterium tuberculosis. He was started on anti-tuberculous medication. After 8 weeks of therapy, the serum creatinine was 1.5 mg/dL and 24 h urine protein 250 mg.

No MeSH data available.


Related in: MedlinePlus

H & E ×20, glomerulus with endocapillary proliferation and lobular accentuation.
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SFU051F1: H & E ×20, glomerulus with endocapillary proliferation and lobular accentuation.

Mentions: As he had renal impairment, proteinuria and normal-sized kidneys, he was subjected to renal biopsy. Three linear grey-white soft tissue bits were reported with 10 glomeruli, all of them showing an increase in mesangial cell proliferation and mesangial matrix. There was lobular accentuation in all of them (Figure 1 and Supplementary Figure 1), a few of them showing neutrophil and lymphocyte infiltration. Tubules showed red blood cell casts. There was focal moderate interstitial lymphomononuclear infiltrate. Blood vessels were unremarkable. Immunofluorescence (IF) showed granular deposition of C3 in the capillary walls, outlining the lobular structure of the glomerulus. In addition IgG was also found, but was of less intensity. IgM, IgA, C1q and light chains were absent. The diagnosis was membranoproliferative glomerulonephritis. During the hospital stay, one day after renal biopsy patient complained fever. Blood and urine cultures were sterile. Chest radiograph was normal. The ultrasound of the abdomen did not reveal any abnormality. After a week he complained of backache and stiffness at the thoracic spine. Examination revealed muscle spasms and rigidity. The radiographs of the thoracolumbar spine were unremarkable, but the MRI of thoracolumbosacral spine revealed paravertebral abscess (osteitis, discitis and abscess) at D11-D12. CT-guided aspiration of the spinal lesion revealed pus. The pus was interspread with many neutrophils few macrophages, lymphocytes and many fine fibrinous threads with entangled leucocytes. Ziehl Neelsen stain showed acid-fast bacilli confirming the diagnosis of Pott's disease (Figure 2). He was started on anti-tuberculous medication. The anti-tuberculous medication included isoniazid (5 mg/kg per day), rifampin (10 mg/kg per day), pyrazinamide (10 mg/kg per day) and ethambutol (5 mg/kg per day). After 2 weeks of the anti-tuberculous medication, there was improvement in pain and stiffness, but the paedal oedema and facial puffiness persisted. During this phase, he was given ramipril (5 mg bds). He was not started on steroids or other immunosuppressants. He was followed up at 2-week intervals. After 8 weeks of therapy, the pain in the back disappeared, as well as the paedal oedema and facial puffiness. The serum creatinine was 1.5 mg/dL and 24-h urine protein 250 mg.Fig. 1.


Membranoproliferative glomerulonephritis and Pott's disease.

Ram R, Sandeep P, Sridhar AV, Rukumangadha N, Sivakumar V - Clin Kidney J (2014)

H & E ×20, glomerulus with endocapillary proliferation and lobular accentuation.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4377797&req=5

SFU051F1: H & E ×20, glomerulus with endocapillary proliferation and lobular accentuation.
Mentions: As he had renal impairment, proteinuria and normal-sized kidneys, he was subjected to renal biopsy. Three linear grey-white soft tissue bits were reported with 10 glomeruli, all of them showing an increase in mesangial cell proliferation and mesangial matrix. There was lobular accentuation in all of them (Figure 1 and Supplementary Figure 1), a few of them showing neutrophil and lymphocyte infiltration. Tubules showed red blood cell casts. There was focal moderate interstitial lymphomononuclear infiltrate. Blood vessels were unremarkable. Immunofluorescence (IF) showed granular deposition of C3 in the capillary walls, outlining the lobular structure of the glomerulus. In addition IgG was also found, but was of less intensity. IgM, IgA, C1q and light chains were absent. The diagnosis was membranoproliferative glomerulonephritis. During the hospital stay, one day after renal biopsy patient complained fever. Blood and urine cultures were sterile. Chest radiograph was normal. The ultrasound of the abdomen did not reveal any abnormality. After a week he complained of backache and stiffness at the thoracic spine. Examination revealed muscle spasms and rigidity. The radiographs of the thoracolumbar spine were unremarkable, but the MRI of thoracolumbosacral spine revealed paravertebral abscess (osteitis, discitis and abscess) at D11-D12. CT-guided aspiration of the spinal lesion revealed pus. The pus was interspread with many neutrophils few macrophages, lymphocytes and many fine fibrinous threads with entangled leucocytes. Ziehl Neelsen stain showed acid-fast bacilli confirming the diagnosis of Pott's disease (Figure 2). He was started on anti-tuberculous medication. The anti-tuberculous medication included isoniazid (5 mg/kg per day), rifampin (10 mg/kg per day), pyrazinamide (10 mg/kg per day) and ethambutol (5 mg/kg per day). After 2 weeks of the anti-tuberculous medication, there was improvement in pain and stiffness, but the paedal oedema and facial puffiness persisted. During this phase, he was given ramipril (5 mg bds). He was not started on steroids or other immunosuppressants. He was followed up at 2-week intervals. After 8 weeks of therapy, the pain in the back disappeared, as well as the paedal oedema and facial puffiness. The serum creatinine was 1.5 mg/dL and 24-h urine protein 250 mg.Fig. 1.

Bottom Line: The MRI of thoraco-lumbo-sacral spine revealed paravertebral abscess at D11-D12.He was started on anti-tuberculous medication.After 8 weeks of therapy, the serum creatinine was 1.5 mg/dL and 24 h urine protein 250 mg.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Sri Venkateswara Institute of Medical Sciences , Tirupati 500083 , India.

ABSTRACT
The reports of glomerular lesions of kidney due to tuberculosis are sparse. A 48-year-old gentleman, presented with swelling of feet of 3 months duration. As he had renal impairment, proteinuria and normal-sized kidneys, he was subjected to renal biopsy. The light microscopy and immunofluorescence revealed the diagnosis was membrano-proliferative glomerulonephritis. During hospital stay, the patient complained fever and stiffness at thoracic spine. The MRI of thoraco-lumbo-sacral spine revealed paravertebral abscess at D11-D12. The pus aspirated was positive for Mycobacterium tuberculosis. He was started on anti-tuberculous medication. After 8 weeks of therapy, the serum creatinine was 1.5 mg/dL and 24 h urine protein 250 mg.

No MeSH data available.


Related in: MedlinePlus