Marie-Paule Ramée

Rapidly progressive ('crescentic') glomerulonephritis and monoclonal gammapathies.

In 3 patients rapidly progressive glomerulonephritis revealed plasma cell dyscrasia in 2 cases and Waldenstroms macroglobulinemia in the 3rd. Renal biopsy showed proliferative glomerulonephritis with marked endo- and extracapillary (crescentic) proliferation. In case 1, corticosteroids and cyclophosphamide favorably influenced the course of the disease. The 2nd patient was not treated and went on to maintenance hemodialysis. In the 3rd case, plasma exchange and cytotoxic drugs allowed discontinuation of hemodialysis. Thirteen other cases of proliferative glomerulonephritis associated with monoclonal gammapathies have been described in the literature, including 3 with crescents. B-cell dyscrasia should be considered a possible etiology in a patient with crescentic glomerulonephritis. In such case we show that treatment of the hematologic disorder can be followed by a dramatic improvement of renal function.

Non-Hodgkin's lymphoma presenting as acute renal failure: a new case.

Non-Hodgkin’s Lymphoma Presenting as Acute Renal Failure: A New Case C. Christophe Charasse O. Ollivier Colcanap J. Jérôme Bousser B. Bertrand Catroux P. Patrick Morice I. Mourtada A. Alain Pasquiou M.-P. Marie-Paule Ramée N. Nasredine Ghali K. KimSeng Ang P. Pierre Simon Service de Néphrologie, Service de Réanimation, Service de Radiologie, Service d’Hématologie et Service de Dermatologie, CHG La Beauchée, et Laboratoire d’Anatomie Pathologique, Saint Brieuc, Laboratoire d’Anatomie Pathologique, CHU Pontchaillou, Rennes, France

How Frequent Are Hepatitis B Virus Markers in Adult Patients with Glomerular Diseases in a Low Endemic Country

In order to appreciate the frequency of hepatitis B virus (HBV) infection in patients with glomerular diseases in France, a low endemic country, we reviewed the series of patients biopsied in the years 1983-1989 in 2 departments of nephrology differing by the characteristics of the population. In Saint-Brieuc, where the population is almost exclusively Caucasian, with nearly no immigrant, HBsAg was not detected in any of the 86 patients. In Paris, a large number of patients come from highly or intermediately endemic regions. HBsAg was detected in 3 of 209 patients, 2 of the 75 patients with membranous nephropathy and 1 of the 32 patients with minimal-change nephrotic syndrome. These patients came from Africa and Asia. Therefore, in low endemic countries, the role of HBV infection in the etiology of glomerulonephritis is minimal. But, because of the late severity of the disease, screening remains essential in patients belonging to the high-risk groups.