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CEN Case Rep. 2018 May;7(1):83-89. doi: 10.1007/s13730-017-0300-3. Epub 2018 Jan 10.

Renal histopathological findings of retinal vasculopathy with cerebral leukodystrophy.

Author information

1
Department of Internal Medicine, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan. tsubata.y@gmail.com.
2
Department of Pathology, Shinrakuen Hospital, Niigata, Japan.
3
Department of Internal Medicine, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan.
4
Department of Pathology and Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
5
Department of Medical Technology, School of Health Sciences Faculty of Medicine, Niigata University, Niigata, Japan.
6
Divisions of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Abstract

Retinal vasculopathy with cerebral leukodystrophy (RVCL) is a rare autosomal dominant systemic microvascular disease. Neurological disorders and visual disturbance are highlighted as manifestations of RVCL; however, there are few reports focused on nephropathy. Herein, we describe detailed renal histopathological findings in a daughter and father with RVCL, proven by TREX1 genetic analysis. A kidney biopsy of the daughter, 35-year-old with asymptomatic proteinuria, revealed unique and various glomerular changes. Atypical double contour (not tram track-like) of the capillary wall was widely found, an apparent characteristic finding. Glomerular findings were varied due to a combination of new and old segmental mesangial proliferative changes, mesangiolysis, and segmental glomerulosclerosis-like lesions; these changes may be related to endothelial cell damage. Collapsed tufts were also found and thought to be the result of ischemia due to arterial changes. Glomerular findings in a kidney biopsy of the father revealed similarity to the daughter's glomerulus at a relatively advanced stage, but the degree of variety in the glomerular findings was much less. Kidney biopsy findings suggesting endothelial cell damage of unknown etiology need to be considered for possible RVCL.

KEYWORDS:

Autosomal dominant disease; Kidney biopsy; RVCL; Retinal vasculopathy with cerebral leukodystrophy; TREX1

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