Renal amyloidosis associated with crescentic glomerulonephritis

Area of Science:

• Nephrology
• Rheumatology
• Pathology

Background:

• Rheumatoid arthritis is a chronic inflammatory disease that can affect multiple organs.
• Renal involvement in rheumatoid arthritis can include amyloidosis and glomerulonephritis.
• Crescentic glomerulonephritis is a severe form of kidney inflammation.

Observation:

• A 59-year-old female with a 30-year history of rheumatoid arthritis presented with nephrotic syndrome and rapidly declining renal function.
• Kidney biopsy revealed amyloid deposition in 17 of 28 glomeruli and crescent formation in 20 glomeruli.
• Amyloid deposition was confirmed via Congo red, thioflavin-T staining, and electron microscopy; no immunoglobulin or complement deposition was observed.

Findings:

• Treatment with cyclophosphamide, dipyridamole, heparin, and pulse methylprednisolone did not prevent progressive renal function deterioration, necessitating dialysis.
• Following 3 months of peritoneal dialysis, partial renal function recovery was observed without further medication.
• A repeat kidney biopsy showed advanced glomerular amyloidosis and increased fibrous tissue in crescents.

Implications:

• This case highlights the potential for coincident renal amyloidosis and crescentic glomerulonephritis in long-standing rheumatoid arthritis.
• The findings suggest that peritoneal dialysis may play a role in managing renal dysfunction in such complex cases.
• Further research is needed to understand the interplay between rheumatoid arthritis, amyloidosis, and glomerulonephritis and to optimize treatment strategies.