A Case of Guillain-Barre Syndrome with Focal Segmental Glomerulosclerosis

Abstract

Acute inflammatory polyneuropathy or Guillain-Barre syndrome may be associated with glomerulonephritis, especially membranous nephropathy. This paper details the case of a 73-year-old woman presenting with acute onset of Guillain-Barre syndrome associated with an abnormal urinary sediment and significant proteinuria. Renal biopsy was consistent with focal segmental glomerulosclerosis. Despite an initial response to plasmapheresis, the patient’s polyneuropathy deteriorated and subsequently improved with corticosteroid therapy. Simultaneously, her proteinuria and urinary sediment also improved. This implies that this was not a chance association. A brief discussion of the association between Guillain-Barre syndrome and glomerulopathies is undertaken.

Acute-onset chronic inflammatory demyelinating polyneuropathy with focal segmental glomerulosclerosis

“…An association between inflammatory neuropathies and nephrotic syndrome had previously been reported, with the most frequent renal manifestations being either FSGS or membranous glomerulonephritis . Similar to our patient, renal involvement was suspected in patients with either hypertension or oedma [3,4,7,8], although in some instances proteinura was incidentally diagnosed [1,2,6], suggesting that many cases of concomitant neuro-renal involvement might have remained undiagnosed.…”

“…Similar to those associated with membranous glomerulonephritis [9][10][11][12][13][14][15][16][17][18] and minimal change nephrotic syndrome [19][20][21][22], the neurologic presentations of previously reported cases of FSGS occurring in association with inflammatory neuropathies are diverse. These cases include patients with monophasic disease, like GBS [3,5,6], and those with a relapsing course, including CIDP [2,4,7,8] and relapsing GBS [1], suggesting heterogeneity in the time course and severity of neuropathy in these patients. Our patient presented with acute-onset CIDP, and her weakness at the nadir of her exacerbation was very severe requiring ventilatory failure.…”

“…Their underlying glomerular pathologies include focal segmental glomerulosclerosis (FSGS) [1][2][3][4][5][6][7][8], membranous glomerulonephritis [9][10][11][12][13][14][15][16][17][18] and minimal change disease [19][20][21][22]. Here we describe a patient who synchronously developed acute-onset CIDP and FSGS, whose severe clinical manifestations were responsive to immunotherapy.…”

Guillain‐Barré syndrome patient weaned off ventilation after 22 months

“…8 On the other hand, the relationship between GBS and focal segmental glomerulonephritis seems anecdotal with only two case reports from the 1990s documenting this relationship between GBS and FSGS. 9,10 Our patient behaved similarly to these cases, showing improvement in the kidney function as he recovered from his GBS. Eventually, the deterioration in both renal and neurological states led to the patient's death.…”

Guillain-Barré Syndrome Associated with Minimal Change Glomerulopathy and Tubular Dysfunction – Related to Acetone-Based Organic Solvent?

“…The most prevalent histological characteristic in these cases is membranous glomerulopathy [8], while minimal change nephrotic syndrome or focal segmental glomerulosclerosis with Guillain-Barré syndrome has also occasionally been reported [9][10][11]. The neuritis and nephrosis are apparently related and may be mediated by disordered immunoregulations [8,9].…”