Boussaid Soumaya, Tbini Houssem, Rekik Sonia, Mami Ikram, Ben Fatma Lilia, Jammali Samia, Bargaoui Hela, Sahli Hela, Rais Lamia, Zouaghi Mohamed Karim, Elleuch Mohamed
Rheumatology Department, Rabta Hospital, Tunis, Tunisia.
Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Mediterr J Rheumatol. 2023 Jun 30;34(2):257-261. doi: 10.31138/mjr.34.2.257. eCollection 2023 Jun.
During its course, spondyloarthritis (SpA) may be associated with extra-articular manifestations affecting several organs. Renal involvement is one of the most common extra-articular manifestations and is dominated by secondary amyloidosis (AA), immunoglobulin A (IgA) nephropathy, and urolithiasis. Other nephropathies such as Focal segmental glomerulosclerosis and hyalinosis (FSGS) are less common and are limited to few case reports.
We report the case of a patient followed for axial SpA, who consulted, after being lost to follow-up for 3 years, for elevated blood pressure and edema of both lower limbs associated with an hydrocele and bilateral pleural effusion. Biological examinations showed hypoproteinemia, hypoalbuminemia, and proteinuria. In this context of nephrotic syndrome, the diagnosis of FSGS was confirmed by renal biopsy. Furthermore, the etiological investigation ruled out the causes of secondary FSGS.
Renal involvement is a sign of severity in SpA. Its detection and management should be part of the overall management of SpA.
在病程中，脊柱关节炎（SpA）可能与影响多个器官的关节外表现相关。肾脏受累是最常见的关节外表现之一，主要包括继发性淀粉样变性（AA）、免疫球蛋白A（IgA）肾病和尿路结石。其他肾病，如局灶节段性肾小球硬化和玻璃样变性（FSGS）则较少见，仅有少数病例报告。
我们报告一例接受轴向SpA治疗的患者，该患者在失访3年后前来就诊，出现血压升高和双下肢水肿，并伴有鞘膜积液和双侧胸腔积液。实验室检查显示低蛋白血症、低白蛋白血症和蛋白尿。在这种肾病综合征的背景下，肾活检确诊为FSGS。此外，病因学调查排除了继发性FSGS的病因。
肾脏受累是SpA病情严重的一个标志。其检测和管理应成为SpA整体管理的一部分。
