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NDT Plus Advance Access originally published online on August 29, 2008
NDT Plus 2009 2(1):55-58; doi:10.1093/ndtplus/sfn143
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Whipple's disease: often a late diagnosis and a rare cause of nephropathy

Lisette C. Kramer1, Theo A. J. M. Manschot2, Jos N. M. Barendregt1 and Jitty M. Smit1

1 Department of Internal Medicine
2 Department of Pathology, Gelre ziekenhuizen, Apeldoorn, The Netherlands

Correspondence: Correspondence and offprint requests to: Jos N. M. Barendregt, Department of Internal Medicine, Gelre ziekenhuizen Apeldoorn, Postbus 9014, 7300 DS Apeldoorn, The Netherlands. Tel: +31-55-8446046; Fax +31-55-5818170; E-mail: j.barendregt@gelre.nl

Key Words: nephrotic syndrome • secondary amyloidosis • Whipple's disease

Received for publication May 23, 2008. Accepted for publication August 7, 2008.

The first 150 words of the full text of this article appear below.


   Introduction
 
Whipple's disease (WD), first described in 1907 [1], is an uncommon entity caused by Tropheryma whipplei, an actinomycete, infecting macrophages. The first isolation of the bacillus was described in 2000 [2]. Massive infiltration of the tissue of affected organs by macrophages staining positive with periodic acid-Schiff (PAS) typifies WD.

Typical findings in WD include fever, nondestructive polyarthritis, abdominal symptoms including diarrhoea and wasting, endocarditis, lymphadenopathy, uveitis and neurological symptoms. By the time of diagnosis, diarrhoea and wasting may be prominent symptoms, but these are usually preceded by a period of migratory arthralgias and myalgias that can last for many years [3]. General physicians rather than gastroenterologists see the patients in this stage of the disease.

Little is known about the epidemiology, but WD is an extremely rare condition, most often affecting middle-aged European males [3]. The microorganism is ubiquitous and has . . . [Full Text of this Article]


   Case description
 

   Discussion
 

   Teaching points
 

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