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A case of membranoproliferative glomerulonephritis and AA amyloidosis complicated with pulmonary nontuberculous mycobacterial infection

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Abstract

A 75-year-old man was diagnosed with pulmonary nontuberculous mycobacterial (NTM) infection in February 2005 and was treated with rifampicin, ethambutol, and clarithromycin. However, the infection was resistant to treatment, and his chest radiograph showed an abnormality that gradually seemed to aggravate. The patient’s sputum was positive for Mycobacteria. Moreover, the patient had dyspnea and an underlying chronic inflammation in the lungs. He visited our hospital because of dyspnea and leg edema in June 2011. Laboratory evaluation on admission revealed proteinuria (6 g/day) and decreased serum total protein (5.8 g/dL) and albumin (1.6 g/dL) levels, indicating nephrotic syndrome. Percutaneous renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) in the acute stage and AA amyloidosis of mild degree. AA amyloidosis was also diagnosed histologically on gastric and colonic biopsy, in addition to renal biopsy. His renal function decreased gradually, and therefore, he underwent hemodialysis therapy in January 2012. However, his gastrointestinal-related symptoms persisted, and his appetite diminished, because of which he had become severely malnourished; he died 8 months later. This is a rare case of a patient with two different renal lesions (MPGN and AA amyloidosis) complicated with NTM. Our case suggests that MPGN and amyloidosis should be considered in elderly patients with nephrotic syndrome onset and chronic inflammation.

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References

  1. Morimoto K, Iwai K, Ohmori M, et al. Nontuberculous mycobacteriosis mortality in Japan. Kekkaku. 2011;86:547–52.

    PubMed  Google Scholar 

  2. The Nontuberculous Mycobacteriosis Control Committee of the Japanese Society for Tuberculosis. Scientific Assembly for Infection and Tuberculosis of the Japanese Respiratory Society. Guidelines for chemotherapy of pulmonary nontuberculous mycobacterial disease—2012 revised version. Kekkaku. 2013;88:29–32.

    Google Scholar 

  3. Osoreda H, Kobayashi H. Chronological change of primary type pulmonary Mycobacterium avium-intracellulare complex infection. Kekkaku. 2010;85:447–52.

    PubMed  Google Scholar 

  4. Yokoyama H, Sugiyama H, Sato H, et al. Committee for the Standardization of Renal Pathological Diagnosis and for Renal Biopsy and Disease Registry of the Japanese Society of Nephrology, and the Progressive Renal Disease Research of the Ministry of Health, Labour and Welfare of Japan. Clin Exp Nephrol. 2012;16:903–20.

    Article  PubMed  Google Scholar 

  5. Bomback AS, Appel GB. Pathogenesis of the C3 glomerulopathies and reclassification of MPGN. Nat Rev Nephrol. 2012;8:634–42.

    Article  CAS  PubMed  Google Scholar 

  6. Sethi S, Nester CM, Smith RJ. Membranoproliferative glomerulonephritis and C3 glomerulopathy: resolving the confusion. Kidney Int. 2012;81:434–41.

    Article  PubMed Central  PubMed  Google Scholar 

  7. West CD. Childhood membranoproliferative glomerulonephritis: an approach to management. Kidney Int. 1986;29:1077–93.

    Article  CAS  PubMed  Google Scholar 

  8. Cameron JS, Turner DR, Heaton J, Williams DG, et al. Idiopathic mesangiocapillary glomerulonephritis. Comparison of types I and II in children and adults and long-term prognosis. Am J Med. 1983;74:175–92.

    Article  CAS  PubMed  Google Scholar 

  9. Rennke HG. Secondary membranoproliferative glomerulonephritis. Kidney Int. 1995;47:643–56.

    Article  CAS  PubMed  Google Scholar 

  10. Matsuo S, Imai E, et al. Guidelines for the treatment of nephrotic syndrome. Nihon Jinzo Gakkai Shi. 2011;53:78–122.

    Google Scholar 

  11. Pecchini F, Bufano G, Ghiringhelli P. Membranoproliferative glomerulonephritis secondary to tuberculosis. Clin Nephrol. 1997;47:63–4.

    CAS  PubMed  Google Scholar 

  12. Meyrier A, Valensi P, Sebaoun J. Mesangio-capillary glomerulonephritis and the nephrotic syndrome in the course of disseminated tuberculosis. Nephron. 1988;49:341–2.

    Article  CAS  PubMed  Google Scholar 

  13. Toyoshima H, Kusaba T, Yamaguchi M. Cause of death in autopsied RA patients. Ryumachi. 1993;33:209–14.

    CAS  PubMed  Google Scholar 

  14. Gertz MA, Kyle RA. Secondary systemic amyloidosis: response and survival in 64 patients. Medicine (Baltimore). 1991;70:246–56.

    Article  CAS  Google Scholar 

  15. Lachmann HJ, Goodman HJ, Gilbertson JA, et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007;356:2361–71.

    Article  CAS  PubMed  Google Scholar 

  16. Zaizen Yukihiro, Arita Kazuhiro, Kawano Hiroshi, et al. Case report of AA amyloidosis associated with cystic infection during the course of non-tuberculous mycobacteriosis. Kokyu Junkan. 2007;55:237–41.

    Google Scholar 

  17. Shinozuka N, Kasamatsu N, Seto T, et al. A fatal case of pulmonary non-tuberculous mycobacteriosis with reactive AA amyloidosis. Nihon Kokyuki Gakkai Zasshi. 2007;45:636–42.

    PubMed  Google Scholar 

  18. Haga Takahiro, Kasamatsu Norio, Kobayashi Takeshi, et al. A case of pulmonary nontuberculous mycobacteriosis with reactive AA amyloidosis exacerbated in spite of various antimicrobial therapy. Jpn J Chest Dis. 2009;68:245–51.

    Google Scholar 

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Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Japan Community Health care Organization, Isahaya Health Insurance General Hospital, 24-1, Eisyohigashi-machi, Isahaya, Nagasaki, 854-8501, Japan

    Kiyokazu Tsuji, Hideyuki Arai, Kenta Torigoe, Ayuko Tokuyama & Yoshiaki Muraya

  2. Wajinkai Hospital, Nagasaki, Japan

    Akira Furusu

  3. Department of Tumor and Diagnostic Pathology, Atomic Bone Disease Institute, Nagasaki University, Nagasaki, Japan

    Masahiro Nakashima

  4. Nagasaki Harbor Medical Center Community Hospital, Nagasaki, Japan

    Takashi Taguchi

  5. Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan

    Yoko Obata

  6. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan

    Yoko Obata, Tomoya Nishino & Shigeru Kohno

Authors
  1. Kiyokazu Tsuji
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  2. Hideyuki Arai
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  3. Akira Furusu
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  4. Kenta Torigoe
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  5. Ayuko Tokuyama
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  6. Yoshiaki Muraya
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  7. Masahiro Nakashima
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  8. Takashi Taguchi
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  9. Yoko Obata
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  10. Tomoya Nishino
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  11. Shigeru Kohno
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Corresponding author

Correspondence to Hideyuki Arai.

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Tsuji, K., Arai, H., Furusu, A. et al. A case of membranoproliferative glomerulonephritis and AA amyloidosis complicated with pulmonary nontuberculous mycobacterial infection. CEN Case Rep 4, 24–30 (2015). https://doi.org/10.1007/s13730-014-0134-1

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  • DOI: https://doi.org/10.1007/s13730-014-0134-1

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