Renal amyloidosis associated with crescentic glomerulonephritis

A case of renal amyloidosis coincidentally associated with crescentic glomerulonephritis is described. A 59-year-old female with 30 years' history of rheumatoid arthritis developed nephrotic syndrome followed by rapid deterioration of renal function. Among 28 glomeruli in a kidney biopsy specimen, glomerular amyloid deposition was present in 17 and crescent formation in 20. Only one glomerulus was free from amyloid deposition or crescent. The amyloid deposition was clearly demonstrated by congo red, thioflavin-T staining as well as electron-microscopic examination. Glomerular deposition of immunoglobulins and/or complements were not noted. While cyclophosphamide, dipyridamole, and heparin followed by pulse methylprednisolone were given, the renal function deteriorated progressively and dialysis was initiated. Renal function, however, recovered partially without medication after peritoneal dialysis of 3 months' duration. The second renal biopsy revealed the progression of glomerular amyloid deposition and the increase in fibrous component of crescent.