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Abstract

A.-L. Vaboe, S. Leh and T. Forslund

¹Renal Research Group, Institute of Medicine, ²Department of Pathology, Gades Institute, Haukeland University Hospital, Bergen, Norway, and
³Department of Medicine, Central Hospital of Jyväaskylä, Jyväaskylä, Finland
This is the first report from Norway of a patient with interstitial nephritis and renal failure due to non-fulminant hepatitis A virus (HAV) infection. HAV infection was confirmed by positive anti-HAV IgM serology. All tests for other virus infections were negative. At admittance serum creatinine (s-Creat) and blood urea nitrogen (BUN) concentration were 539 mmol/l and 32.6 mmol/l increasing the following days to 890 mmol/l and 39.9 mmol/l, respectively. Nine courses of hemodialysis had to be given. Kidney biopsy specimen showed interstitial edema, lymphocytic cell infiltration and acute tubular injury with normal glomeruli. Examination with immunohistochemistry was negative. In contrast to the findings associated with HBV and HCV infection in which glomerular disease is predominantly found, the HAV infection in our patient was associated with interstitial nephritis and acute tubular necrosis. The prognosis of the renal failure due to HAV infection was good although the recovery was substantially delayed.

Abstract

T. Forslund, J. Ahonen, E. Elomaa, T. Parviainen and I. Matinlauri

¹Renal Unit, ²Division of Rheumatology, Department of Medicine, ³Department of Radiology, ⁴Department of Clinical Physiology, Central Finland Health Care District Hospital of Jyväskylä, and ⁵Department of Tissue Typing, Finnish Red Cross, Blood Service, Helsinki, Finland
We detected de novo seropositive erosive rheumatoid arthritis (RA) in a patient seven years after successful cadaveric kidney transplantation (RTx). RA developed in spite of treatment with cyclosporine A (CyA), methylprednisolon (MP) and azathioprine (Aza), compounds often also used for treatment of active RA. Renal failure was due to diabetes mellitus (DM) nephropathy. Besides a slight increase in C-reactive protein (CRP) concentration two years after RTx, the clinical symptoms of RA were observed seven years after RTx. RA was confirmed by X-ray examination, isotopic skeletal scan and positive serum RA factor. After switching Aza to methotrexate (Mtx) treatment, his symptoms disappeared and CRP concentration returned to normal. Our patient had HLA DRB1*0101, *0401 alleles and DQB1*0501, *0302 alleles which have strong genetic association with both DM and RA. To our best knowledge, this is the first case in which de novo seropositive erosive RA developed while on treatment with triple immunosuppression after RTx. The immunosuppressive treatment probably masked the inflammation and symptoms of RA.Correspondence to:
T. Forslund, MD, PhD
Head of Renal Unit
Department of Internal Medicine
Central Finland Health Care District Hospital of Jyväskylä
40100 Jyväskylä, Finland
Email: [email protected],[email protected]

Abstract

Clinical Nephrology, Vol. 75 – Suppl. 1/2011 (S42-S46)

Remission of membranous glomerulonephritis after pancreatectomy for pancreatic neuroendocrine neoplasm – a rare coincidence

T. Forslund¹, I. Kellokumpu², E. Elomaa³, J. Arola⁴ and K. Nuorva⁵

¹Division of Nephrology, Department of Internal Medicine, ²Department of Abdominal Surgery, ³Department of Clinical Radiology, Central Finland Health Care District Hospital, Jyväskylä, ⁴Department of Pathology, University of Helsinki and HUSLAB, Helsinki, and ⁵Department of Pathology, Central Finland Health Care District Hospital, Jyväskylä, Finland
The concomitant existence of a non-malignant neuroendocrine tumor (NET) and membranous glomerulonephritis (MGN) is rare. We report a subject with kidney biopsy proven MGN and nephrotic syndrome in which a computerized scan tomography (CT) examination was performed revealing a pancreatic tumor. A pancreatectomy was performed and the tumor was shown to be a non-malignant NET with a malignant potential. Although treatment with corticosteroids was initiated remission of MGN was observed within the next month after pancreatectomy. The rapid remission observed shortly after pancreatectomy pointed to that tumor removal contributed to, and that neither spontaneous nor corticosteroid treatment alone did induce the rapid remission of the MGN. The coexistence of the two disorders NET and MGN is very rare, however. This is the first report on remission of MGN after pancreatectomy for a NET.Correspondence to:
T. Forslund, MD, PhD, Associate Professor
Division of Nephrology, Department of Medicine
Central Finland Health Care District Hospital
40620 Jyväskylä, Finland
Email: [email protected]

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