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Juvenile rheumatoid arthritis and renal amyloidosis (case report)
S Kavukçu1, M Türkmen, O Saatçi
1Department of Paediatrics, Dokuz Eylül University, Faculty of Medicine, Inciralti, Izmir, Turkey.
Insights
Juvenile rheumatoid arthritis (JRA) can cause kidney problems like proteinuria and hypertension. This case highlights secondary renal amyloidosis as a complication, stressing the need for regular screening during JRA management.
Area of Science:
- Pediatric Rheumatology
- Nephrology
- Clinical Medicine
Background:
- Juvenile rheumatoid arthritis (JRA) is associated with various clinical renal abnormalities, including hematuria, proteinuria, abnormal urinary sediment, decreased renal function, and hypertension.
- These renal issues may stem from renal amyloidosis or nephrotoxic medications used in treatment.
Observation:
- A case report of an 11-year-old boy with JRA since infancy, treated with steroids for a decade, presenting with a history of hypertension and cataracts.
- Renal biopsy was performed to investigate persistent proteinuria, revealing secondary renal amyloidosis as the underlying cause.
Findings:
- The renal biopsy confirmed secondary amyloidosis as a complication of long-standing juvenile rheumatoid arthritis.
- This underscores the potential for serious renal involvement in children with JRA, even with prolonged steroid therapy.
Implications:
- Emphasizes the critical importance of investigating and screening for amyloidosis in the long-term follow-up of children diagnosed with JRA.
- Highlights the need for vigilant monitoring of renal function and early detection of complications to improve patient outcomes.
Abstract:
Clinical renal abnormalities, including haematuria, proteinuria, abnormal urinary sediment, decreased renal functions and hypertension are relatively common in children with juvenile rheumatoid arthritis (JRA). These findings may be due to renal amyloidosis or administration of drugs that are potentially nephrotoxic. The case of an 11 years old boy diagnosed as JRA at 4.5 months of age and treated with steroids for 10 years is presented. In his history he had hypertension for 5 years and cataract for one year. Renal biopsy was done to evaluate the aetiology for proteinuria, which was overlooked before his admission to our Department. Secondary renal amyloidosis due to JRA was found at biopsy. The importance of investigation for amyloidosis during the long-term follow-up of JRA is reemphasized.