Renal amyloidosis secondary to childhood tuberculosis

Abstract

Childhood renal amyloidosis is a rare entity and is mostly secondary in nature. We describe two cases of renal amyloidosis in association with childhood tuberculosis. The first case was a 10-year-old girl who presented with abdominal tuberculosis and nephrotic syndrome, while the second case was a 5-year-old boy who presented with disseminated tuberculosis and nephrotic syndrome. They were found to have amyloidosis on renal biopsy. The former was treated with anti-tubercular drugs, while the latter required anti-tubercular drugs and steroids. Both the cases showed clinical improvement with remission of nephrotic syndrome. Successful treatment of tuberculosis can result in remission of nephrotic syndrome due to secondary renal amyloidosis. It is important, especially in developing countries, to be aware that tuberculosis continues to be part of the differential diagnosis of amyloidosis in children.

Amyloidosis in a Child with Leucocyte Adhesion Deficiency Type-1: An Unusual Association

“…But it has not been reported in humans with leucocyte adhesion deficiency. It is not unusual to have secondary amyloidosis in the presence of chronic infections and inflammation [10].…”

Early presentation of renal amyloidosis in a patient with pulmonary tuberculosis

“…[4] In this report, the patient presented with signs and symptoms, which are conclusive towards medical renal disease, i.e., pedal edema, proteinuria, and hypoalbuminemia; these findings have been found to be associated with renal amyloidosis. [4,5] Hypercholesterolemia is also found to be a significant finding in patients of renal amyloidosis. [3][4][5] Radiological investigations also aid as supportive evidence towards the disease: chest X-ray suggestive of infiltrative TB lesions with pleural effusion.…”

“…[4,5] Hypercholesterolemia is also found to be a significant finding in patients of renal amyloidosis. [3][4][5] Radiological investigations also aid as supportive evidence towards the disease: chest X-ray suggestive of infiltrative TB lesions with pleural effusion. Similarly other radiological findings namely presence of paraspinal abscess, thoracic abscess, and destruction of ribs are also seen as characteristic features in patients with renal amyloidosis.…”

“…[3] Ultrasonography of abdomen suggested the presence of ascites and medical renal disease. [4,5] For the confirmatory diagnosis of renal amyloidosis and to differentiate whether it is primary or secondary renal amyloidosis, renal biopsy was the investigation of choice, which showed absence of apple-green birefringence in the slides, which were pretreated with permanganate solution, confirming it to be a case of secondary renal amyloidosis. [3][4][5] For the stabilization and improvement in renal function, reduction in protein excretion and partial resolution of amyloid deposits (as assessed in some studies by scintigraphy with radiolabeled serum amyloid P component [SAP]) [6] requires successful treatment of the underlying inflammatory process with surgical resection of the focus of infection or tumor.…”