1 Division of Nephrology and 2 Division of Immunology/Rheumatology and Allergy, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
Correspondence and offprint requests to: Yuh-Feng Lin, Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Number 325, Section 2, Chung-Kung Road, Neihu 114, Taipei, Taiwan. Email: linyf{at}ndmctsgh.edu.tw
Keywords: hypoalbuminaemia; oedema; protein losing enteropathy; systemic lupus erythematosus
A 39-year-old woman was admitted because of marked peripheral oedema. Her haematocrit was 31.0% and her white-cell count was 3500. The urea nitrogen was 9 mg/dl, the creatinine 0.7 mg/dl, the total cholesterol 244 mg/dl, the triglyceride 408 mg/dl and total protein 3.4 g/dl with an albumin of 1.5 g/dl. Other biochemistries were normal. Urinalysis revealed microscopic haematuria with red blood cell casts and a negative dipstick for protein, and twice the 24-h urine collection contained 0.100 and 0.350 g of protein. Anti-nuclear antibody (1:1280), and anti-dsDNA (41 IU/ml, normal <30 IU/ml) were positive. Systemic lupus erythematosus (SLE) was impressed. Renal protein loss due to lupus nephritis was first considered. Kidney biopsy was performed and lupus nephritis WHO class IIa was found. However, the proteinuria was too little to account for the hypoalbuminaemia. Protein losing enteropathy (PLE) was finally proved by Tc-99m albumin scintigraphy, which revealed clear visualization of tracer in the small bowel at 30 min (Figure 1A) and in the large bowel at 24 h (Figure1B), but is normally not seen in normal people (Figure 1C). The patient's symptoms improved excellently with 50 mg prednisolone daily treatment. The dosage of prednisolone was gradually tapered and the patient remained clinically well for 3 years on a maintenance treatment of 5 mg of prednisolone.
|
Conflict of interest statement. None declared.
References