Chronic inflammatory demyelinating polyradiculoneuropathy and severe peripheral oedema: a renal explanation.
Inflammatory demyelinating neuropathies have been associated with membranous and focal sclerosing glomerulonephritis. Here we describe a 58 year old man with a clinical history, physical examination and laboratory investigations consistent with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), who also had severe lower limb and sacral oedema resistant to medical therapy. Mild proteinuria was present and a renal biopsy showed features consistent with focal sclerosing glomerulonephritis (FSGN). The patient's weakness and oedema did not respond to i.v. immunoglobulin or plasmapheresis but responded to high dose oral prednisone. The oedema was not explained by immobility, hypoproteinaemia or local factors. The occurrence of the oedema in a person with CIDP and FSGN and its improvement with prednisone, together with improvement in CIDP and FSGN, suggests that it was immune mediated, possibly due to increased capillary permeability. The presence of renal disease in patients with inflammatory demyelinating neuropathies may be more common than currently realised.
Henderson
R D
RD
Department of Neurology, Mayo Clinic, Rochester, USA. Henderson.Robert@mayo.edu
Healy
H G
HG
McCombe
P A
PA
Lander
C M
CM
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004487:Edema / Q000188:drug therapy / Q000209:etiology*; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007678:Kidney Glomerulus / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000150:complications* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D012445:Sacrococcygeal Region
D000893:Anti-Inflammatory Agents; D011241:Prednisone