Necrotizing Glomerulonephritis and Renal Cholesterol Embolization
T. Hannedouche, M. Godin, H. Courtois, T. Ducastelle, A. Delpech, J. Tayot, J.P. Fillastre
1986
Nephron
Dear Sir, Renal cholesterol embolization as a direct cause of necrotizing glomerulonephritis has recently been described by Goldman et al. [1]. This condition is exceedingly rare, and we wish to report a case of similar nature. A 79-year-old woman with a 10-year history of hypertension and a 3-year history of peripheral vascular disease was hospitalized for generalized malaise, severe myalgia, and weight loss of 12 kg in 7 months. Her only medication was atenolol 100 mg a day. On examination
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... blood pressure was 160/80 mm Hg. The cardiopul-monary exam was unremarkable. Both temporal arteries were difficult to palpate, and no pulses were felt in the lower limbs. Bilateral femoral bruits were heard. Subcutaneous nodules, 2-3 cm in diameter, were present over the flanks, arms and thighs. Peripheral edema was not noted. Laboratory investigations revealed: normocytic normochromic anemia (Hb = 5.2 mmol/l, erythrocyte sedimentation rate of 102 mm at 1 h, total protein = 48 g/l, serum albumin = 26 g/l). Renal function had deteriorated rapidly, the serum creatinine at the time of hospi-talization was 950 µmol/l, having been 230 and 123 µmol/l3 and 5 months previously. Proteinuria (2 g/24 h) and hematuria (2 million RBC/min) were present. Abdominal ultrasound revealed normal-sized kidneys, an aortic aneurysm 32 mm in diameter, and bilateral iliac artery stenosis. Complement concentrations were: CH50 = 125 lU/ml (80-120), C3 = 0.50 g/l (0.60-1.20), C4 = 0.19 g/l (0.20-0.40). Circulating immune complexes were detected using the PEG technique. Antinuclear antibodies were present at 1/500 homogeneous. Circulating anti-glomerular basement antibodies were not detected. Temporal artery and muscle biopsies were normal. A biopsy of the skin lesions showed capillary dilatation in the superficial and intermediate dermis with red blood cells filling the vascular lumina, and pericapillary polynuclear infiltration. No cholesterol crystals were seen, and no necrosis was present. The clinical picture suggested systemic arteritis although a specific diagnosis could not be made. Prednisone 1 mg/kg and cyclophosphamide 2 mg/kg were prescribed. Oligoanuria ensued and alternate day hemodialysis was instituted. Open renal biopsy was performed. Twenty-six of 30 glomeruli
doi:10.1159/000183683
pmid:3945369
fatcat:6eypezcrqrgzvalhjyyp7djbsi