Leyla MEMİŞ, Funda DEMİRAĞ, Aydın YILMAZ, Şükran ATİKCAN, Figen ATALAY, Dilek ERNAM

An unusual renal presentation of Wegener's granulomatosis

Altmışüç yaşında kadın hasta yaygın eklem ağrıları, mikrohematüri ve toraks bilgisayarlı tomografisinde görülen sağ alt lob bazal segment düzeyinde plevraya oturmuş solid kitle lezyonu nedeniyle kliniğimize kabul edildi. Hastaya sağ torakotomi, "wedge" rezeksiyon ve dekortikasyon uygulandı. Histopatolojik inceleme ve Wegener granülomatözü tanısı kondu. Serum ve doku örneklerinde antinötrofil sitoplazmik antikor (c-AMCA) pozitif bulundu. Renal biyopsi örneğinin histopatolojik incelemesi tubulointersüsyel nefrit olarak raporlandı. Biz olgumuzu alışılmamış böbrek tutulumu nedeniyle literatür eşliğinde sunduk.

Alışılmamış böbrek tutulumu ile seyreden Wegener granülomatözü olgusu

A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive anti neutrophil cytoplasmic antibodies (c-AMCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologie type of renal involvement by reviewing the literature.

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1. Stone JH, Tun W, Hellman DB. Treatment of non-life threatening Wegener’s granulomatosis with methotrexate and daily prednisone as initial therapy of choice. J Rheumatol 1999; 26: 1134-9.
2. Rubin LJ. Pulmonary vasculitis and primary pulmonary hypertension. In: Murray JF, Nadel JA (eds). Textbook of Respiratory Medicine. Philadelphia: WB Saunders Company, 1994: 1683-709.
3. Leavitt RY, Fauci AS, Block DA, et al. The American College of Rheumatology 1990 Criteria for the classification of Wegener’s Granulomatosis. Arthritis Rheum 1990; 33: 1101-7.
4. Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener’s granulomatosis prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983; 98: 76-85.
5. Stausst L, Lieberman KL,Churg J. Pulmonary vasculitis. In: Fishman AP (ed). Pulmonary Diseases and Disorders. New York: McGraw-Hill Book Company, 1988: 1127-56.
6. Fauci AS, Wolff SM. Wegener’s granulomatosis; studies in eighteen patients and a review of literature. Medicine 1973; 52: 535-61.
7. Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener’s granulomatosis: An analysis of 158 patients. Ann Intern Med 1992; 116: 488-98.
8. Fontenot A, Jennings C, King TE. Pulmonary opacities and glomerulonephritis in a 15-year old boy. Chest 1998; 113: 525-7.
9. Langford CA, HoffmanGS. Wegener’s granulomatosis. Thorax 1999; 301: 629-37.
10. Fujita T, Ohi H, Endo M, Ohsawa I, Kanmatsuse K. Level of red blood cells in the urinary sediment reflects the degree of renal activity in Wegener’s granulomatosis. Clin Nephrol 1998; 50: 284-8.
11. Conn DL, Hunder GG, O’Duffy JD. Vasculitis and related disorder. In: Kelley WN, Herms ED, Ruddy S, Sledge CB (eds). Textbook of Rheumatology. New York: WB Saunders Company, 1993: 1077-102.
12. Sullivan EJ, Hoffman GS. Pulmonary vasculitis. Clin Chest Med 1998; 19: 759-76.
13. Bajema IM, Hagen EC, Van Der Woude FJ, Bruijn JA. Wegener’s granulomatosis: A meta-analysis of 349 literary case reports. J Lab Clin Med 1997; 129: 17-22.
14. Cotran RS. The kidney and its collecting system. In: Robbins SL, Kumar V (eds). Basic Pathology. Philadelphia: WB Saunders Company, 1987: 457-91.
15. Puolijoki H, Liippo K, Raitio M, Tala E. Wegener’s granulomatosis treatment under revision? Respiration 1992; 59: 116-8.
16. Israel HL. Sulfamethoxazole-trimethoprim therapy for Wegener’s granulomatosis. Arch Intern Med 1988; 148: 2293-5.