Gyl Eanes Barros SilvaI; Roberto Silva CostaI; Márcio DantasII
IDepartamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP IIDivisão de Nefrologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP
A 46-year-old woman with a history of diabetes, drug addiction, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) was presented to our department with a 4-month history of edema, fever, and cough. Chest radiography showed an opacification in the upper lobe of the left lung, but laboratory tests were negative for tuberculosis (TB). Nevertheless, the treatment for pulmonary TB was started. Serum creatinine and albumin levels were 0.8mg/dL and 2.5g/dL, respectively. The urinary protein excretion was 7.5g/24h. A renal biopsy performed six weeks after beginning the TB treatment showed a mild mesangial expansion of amorphous and acellular pale eosinophilic material. The material had affinity for Congo red stain (Figure A) that was lost after exposure to KMnO4. The interstitial area shows foci of mixed inflammatory cell infiltrate and epithelioid granulomas with Langhans giant cells and central necrosis (Figure B). Probably due to treatment, Ziehl-Neelsen stains were negative. The final diagnosis was secondary amyloidosis and granulomatous interstitial nephritis compatible with tuberculosis. Two years later, the albumin level was 4.2g/24h, serum creatinine was 1.0mg/dL, proteinuria decreased to 1.2g/24h, and all symptoms disappeared.
We report this case to emphasize the importance of renal biopsy in patients with infectious diseases (HCV, HIV, TB) and nephropathy. In addition, this is the first case in which a renal biopsy showed the concomitant diagnosis of TB granulomas and AA amyloidosis deposits.
REFERENCES
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2. Lannoy LH, Cortez-Escalante JJ, Evangelista MS, Romero GA. Tuberculosis incidence and risk factors among patients living with HIV/AIDS in public health service institutions in Brasilia, Federal District. Rev Soc Bras Med Trop 2008; 41:549-555. [ Links ]
3. Silva Júnior GB, Barbosa OA, Barros RM, Carvalho PR, Mendoza TR, Barreto DM, et al. Amiloidose e insuficiência renal crônica terminal associada à hanseníase. Rev Soc Bras Med Trop 2010; 43:474-476. [ Links ]
Address to:
Dr. Gyl Eanes Barros Silva
Deptº Patologia/FMRP/USP
Av. Bandeirantes 3900
14048-900 Ribeirão Preto, SP, Brasil
Phone/Fax: 55 16 3633-1068
e-mail: gyleanes@fmrp.usp.br
Received in 08/07/2011
Accepted in 11/10/2011
