Secondary amyloidosis associated with tuberculosis in renal biopsy

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Secondary amyloidosis associated with tuberculosis in renal biopsy

Amiloidose secundária associada à tuberculose numa biópsia renal

Gyl Eanes Barros Silva^I; Roberto Silva Costa^I; Márcio Dantas^II

^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

^{Address to}

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.

Received in 08/07/2011

Accepted in 11/10/2011

• 1. Ruffino-Netto A. Tuberculose: a calamidade negligenciada. Rev Soc Bras Med Trop 2002; 35:51-58.
• 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.
• 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.

Publication Dates

• Publication in this collection
  06 Jan 2012
• Date of issue
  Dec 2011