Gold nephropathy and renal amyloidosis in a patient with rheumatoid arthritis

A 71-year-old Caucasian woman with rheumatoid arthritis, who had been treated with gold salts for 19 months, developed a significant proteinuria associated with nephrotic syndrome and renal impairment. Her renal biopsy revealed the unusual simultaneous occurrence of gold nephropathy and renal amyloidosis and she was treated by gold withdrawal, methylprednisolone pulses and azathioprine, with a good remission of symptoms. We describe the case and discuss the possible cause(s) of similar renal involvement and the results obtained with the combined therapy of steroids and cytotoxic drugs.