Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases
- PDF / 1,980,651 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 65 Downloads / 180 Views
CASE REPORT
Secondary renal amyloidosis associated with asbestos‑related pleuropulmonary diseases Ryoko Shibata1 · Tomomi Ozaki1 · Kazuhiro Tada1 · Takashi Aoyama2 · Maho Watanabe1 · Naoko Himuro1 · Koji Takahashi1 · Kenji Ito1 · Tetsuhiko Yasuno1 · Katsuhisa Miyake1 · Kosuke Masutani1 · Noriko Uesugi3 · Kazuki Nabeshima3 · Hitoshi Nakashima1 Received: 19 March 2020 / Accepted: 6 June 2020 © Japanese Society of Nephrology 2020
Abstract Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations. Keywords AA amyloid · Kidney biopsy · Latent period · Malignant mesothelioma · Nephrotic syndrome
Introduction Asbestos comprises a group of fibrous minerals that are chemically inert, durable, resistant to heat and fire, and do not conduct electricity. These natural characteristics made asbestos useful in the construction, automotive, and shipbuilding industries from the late nineteenth century. However, numerous workers with occupational asbestos exposure developed non-malignant diseases, such as asbestosis, * Kosuke Masutani kmasutani@fukuoka‑u.ac.jp 1
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7‑45‑1, Jonan‑ku, Fukuoka 814‑0180, Japan
2
Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
3
Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
benign pleural effusion, and diffuse pleural thickening, as well as malignant mesothelioma and lung cancer [1, 2]. Although industrial use of asbestos is prohibited in many countries, asbestos-related diseases will probably continue to emerge for another decade or so, bec
Data Loading...
