Tuesday, November 29, 2011

CONSULT ROUNDS: Sjogren's Syndrome and Glomerular Diseases?

What is the association of Sjogren's Syndrome(SS) with any glomerular disease..

Well, besides few cases reports scattered in the literature, there are two large case series that highlight this nicely.

In 2001, Bossini et al described the clinical and morphological features of kidney involvement in SS.  Sixteen patients (27%) had laboratory evidence of tubular and/or glomerular dysfunction.  Renal biopsies from nine patients showed tubulointerstitial nephritis in six and glomerular disease in three. The three diagnosis were MPGN, mesangiproliferative and membranous. Patients with renal involvement had a significantly shorter disease duration compared with patients without renal abnormalities.
A more recent study in CJASN looked at more number of patients and at least 24 biopsies of SS patients showing mostly tubular interstitial disease but the glomerular disease was a mixed bag: FSGS, mild mesangial sclerosis, MPGN, minimal change disease( 1 case), membranous, were the ones reported. The paper is free access ( look below). Four patients (17%) were diagnosed with lymphoma during their follow-up. Below is a pie chart from the paper that had 24 cases and the distribution on the biopsy. Overall, not a very common thing to see in SS, but glomerular disease is likely.

From CJASN 2009

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