CLINICAL CASE 7

What is the most common renal biopsy finding in patients with primary Sjorgen's Syndrome?

FSGS	2 (16%)
Minimal Change Disease	1 (8%)
Chronic Tubularinterstitial Disease	9 (75%)
Mesangioproliferative Glomerulonephritis	0 (0%)

Correct. Most common finding in Sjorgen's Syndrome(SS) is Chronic TI disease.

A case series in CJASN 2009 supports chronic TIN as the predominant kidney biopsy finding in patients with renal involvement from SS but also illustrates diverse glomerular lesions.  Treatment with glucocorticoids or other immunosuppressive agents appears to slow progression of renal disease. Screening for renal involvement in SS should include urinalysis, serum creatinine, and KB where indicated. KB with characteristic findings (TIN) should be considered as an additional supportive criterion to the classification criteria for SS

because it may affect management and renal outcome. Other small cases found in that series included FSGS, Minimal Change, MPGN and membranous as well. Distal RTA is another clinical finding that is fairly common in SS patients.

References:

Tu WH, Shearn MA, Lee JC, Hopper J Jr: Interstitial nephritis in Sjogren’s syndrome. Ann Intern Med 69: 1163–1170, 1968

http://www.ncbi.nlm.nih.gov/pubmed/18465457

http://cjasn.asnjournals.org/cgi/content/full/4/9/1423