Extract

1Oxford Kidney Unit Churchill Hospital Oxford OX3 7LJ2 Monklands Hospital Airdrie ML6 0JS

Sir,

Nephrologists are accustomed to managing patients with systemic vasculitis. However, some of the rarer vasculitides may be primarily non-renal in their target organ damage and present with a long prodrome. We would like to briefly discuss one such syndrome that may not be well known to the general nephrological community.

Our patient presented aged 32 when, with no risk factors for coronary atheroma, he sustained a myocardial infarction. Aged 40, he presented with fever, bilateral uveitis and renal impairment (serum creatinine 420 mmol/l). Inflammatory markers and autoimmune profile including ANA, ANCA and anti-GBM antibody were normal. Renal biopsy revealed a diffuse proliferative glomerulonephritis with mesangial hypercellularity, irregular granular deposits of C3 in both the mesangium and capillary loops but no features of vasculitis or crescents. He was treated with a course of antibiotics that coincided with the resolution of his symptoms. His serum creatinine improved to 180 mmol/l and remained stable. Over the next 12 years he developed left hemiparesis; bilateral sensorineural deafness needing a cochlear implant; a second myocardial infarction with ventricular arrhythmia needing coronary stenting and an implantable cardioverter defibrillator.

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