J Nephropathol. 2013;2(3):201-203.
doi: 10.12860/JNP.2013.32
PMID: 24475450
PMCID: PMC3891137
Scopus id: 84924933204
  Abstract View: 1279
  PDF Download: 630

Case Report

Concurrent diabetic nephropathy and C1q nephropathy in a young male patient: The first report in literature

*Corresponding author:Ali Momeni, Internal Medicine Department, Hajar Hospital, Shahrekord, Iran. Tel: +989133267459, Fax:+91318 2245 715, Email: ali.momeny@yahoo.com


Background: Systemic AA amyloidosis is a long-term complication of several chronic inflammatory disorders. Organ damage results from the extracellular deposition of proteolytic fragments of the acute-phase reactant serum amyloid A (SAA) as amyloid fibrils. Drug users that inject drug by a subcutaneous route ("skin popping") have a higher chance of developing secondary amyloidosis. The kidneys, liver, and spleen are the main target organs of AA amyloid deposits. More than 90% of patients with renal amyloidosis will present with proteinuria, nephrotic syndrome, or renal dysfunction.

Case presentation: A 37 year-old female presented to the hospital with a one-week history of pain and redness in her right axilla. Her relevant medical history included multiple skin abscesses secondary to "skin popping", heroin abuse for 18 years, and hepatitis C. The physical examination revealed "skin popping" lesions, bilateral costovertebral angle tenderness, and bilateral knee swelling. The laboratory workup was significant for renal insufficiency with a serum creatinine of 5 mg/dL and 14.8 grams of urine protein per 1 gram of urine creatinine. The renal biopsy findings were consistent with a diagnosis of renal amyloidosis due to serum amyloid A deposition and acute tubulointerstitial nephritis.

Conclusions: AA renal amyloidosis among heroin addicts seems to be associated with chronic suppurative skin infection secondary to "skin popping". It is postulated that the chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes is an important factor in the pathogenesis of amyloidosis in these patients. Therefore, AA renal amyloidosis should always be considered in chronic heroin users presenting with proteinuria and renal impairment.

Implication for health policy/practice/research/medical education:

C1q nephropathy (C1qN) is an uncommon glomerulopathy with a significant deposition of C1q in mesangium without clinical evidence of lupus. According to the best of our knowledge, there is not any report on coincidence of diabetes mellitus and C1qN. Prevalence of autoimmune disease is higher in type 1 DM and this may explain the relation between DM and C1qN in our patient.  

Please cite this paper as:Momeni A, Nasri H. Concurrent diabetic nephropathy and C1q nephropathy in a young male patient: the first report in literature. J Nephropathology. 2013; 2(3): 201-203, DOI: 10.12860/JNP.2013.32

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Revised: 29 Jan 2013
First published online: 01 Jul 2013
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