[Nephrotic syndrome as the initial symptom of Crohn disease]

In february 1993, a now 54-year-old man presented with an increased serum-creatinine of 1.7 mg/dl known since september 1992 associated with peripheral edema. He reported painless and infrequent diarrhea during the previous 15 years. Clinically, he showed typical symptoms of a nephrotic syndrome. A renal biopsy revealed an amyloidosis. By further investigations the diagnosis of underlying Crohn's disease could be established. An ileocecal resection and a subsequent immunosuppressive therapy with azathioprine was performed. Following this procedure the serum-creatinine has meanwhile increased to 3.2 mg/dl with the proteinuria remaining stable. Furthermore, the patient developed a renal hypertension. However, at present the patient is otherwise asymptomatic and in a good general condition.