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with a 3-year history of focal segmental glomerulosclerosis&#44; was admitted with bloody and mucoid diarrhea which had been for lasting for 10 days&#46; There was no fever&#44; nausea&#44; vomiting or infection&#46; There was no feature in the patient&#39;s history except diarrhea&#46; Physical examination also was normal&#46; Laboratory investigation demonstrated impaired renal function and proteinuria due to focal segmental glomerulosclerosis&#46; Renal function test which is similar to the old values showed serum creatinine level of 3&#46;15<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#46;8&#8211;1&#46;3&#41;&#44; BUN level of 89<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;17&#8211;43&#41; and 24-h urine protein level of 1876<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#40;&#60;200&#41;&#46; In addition&#44; his erythrocyte sedimentation rate &#40;ESR&#41; was 79<span class="elsevierStyleHsp" style=""></span>mm&#47;h &#40;&#60;20&#41; and C-reactive protein &#40;CRP&#41; was 6&#46;66<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;&#60;0&#46;4&#41;&#46; A large amount of leukocytes and erythrocytes was seen in the stool microscopy&#46; Stool cultures were detected negative twice&#46; Colonoscopy revealed that there were to exudates of millimetric ulcers descending colon&#44; sigmoid colon and rectum&#46; The colon biopsy confirmed the diagnosis of ulcerative colitis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was started on mesalamine&#46; His symptoms showed marked improvements after starting mesalamine treatment&#46; After treatment&#44; laboratory investigation demonstrated&#59; creatinine level of 3&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#46;8&#8211;1&#46;3&#41;&#44; BUN level of 116<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;17&#8211;43&#41;&#44; ESR level of 38<span class="elsevierStyleHsp" style=""></span>mm&#47;h &#40;&#60;20&#41;&#44; CRP level of 0&#46;319<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;&#60;0&#46;4&#41;&#44; and 24-h urine protein level of 2099<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#40;&#60;200&#41;&#46; There were no abnormalities suggestive of nephrotoxicity in patients due to mesalamine&#44; while acute phase reactants declined&#46; The decline in ESR and CRP levels is thought to be in favor of improving ulcerative colitis activation&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A focal segmental glomerulosclerosis after ulcerative colitis treatment with mesalamine and sulfasalazine has been reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Additionally in the literature&#44; there have been several minimal changes in the disease following the treatment of inflammatory bowel disease with mesalamine or sulfasalazine&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#8211;6</span></a> A case report has been published of nephrotic syndrome due to Crohn&#39;s disease with mesalamine treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this case&#44; we discuss about the developed ulcerative colitis in a patient who was followed for focal segmental glomerulosclerosis&#46; Unlike previously reported cases&#44; mesalamine and sulfasalazine have no effect on the togetherness of the two diseases&#46; Although primary and secondary FSGS forms are defined based on the underlying cause&#44; the podocyte damage is a common result eventually&#46; Some genetic factors affect the inflammation which is the main cause of development of the ulcerative colitis&#46; An unknown cause such as genetic&#44; environmental or infections except drugs may be factors in the etiology of these two diseases&#46; Furthermore&#44; an unknown cause can facilitate the development of nephrotoxicity after mesalamine and&#47;or sulfasalazine treatment&#46; In our case&#44; the patient&#39;s renal function did not change significantly after mesalamine treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The coexistence of ulcerative colitis and focal segmental glomerulosclerosis is a rare condition&#46; Mesalamine and&#47;or sulfasalazine which have been used in ulcerative colitis treatment may be nephrotoxic&#46; In our case&#44; we have detected togetherness between ulcerative colitis and non-drug-induced focal segmental glomerulosclerosis&#46; It should be kept in mind that the two diseases may be caused by an unknown factor such as genetic&#44; environmental or infections except drugs&#46;</p></span>"
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Letter to the Editor
A rare cause of diarrhea in patients with focal segmental glomerulosclerosis
Una causa poco frecuente de diarrea en pacientes con glomeruloesclerosis focal y segmentaria
Osman Saglama,
Corresponding author
ossag03@gmail.com

Corresponding author.
, Selman Unverdib, Murat Duranayb
a Department of Internal Medicine, Ankara Training and Research Hospital, Ankara, Turkey
b Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Focal segmental glomerulosclerosis &#40;FSGS&#41; symbolizes a common histologic pattern of glomerular injury associated with numerous disease mechanisms&#46; Ulcerative colitis &#40;UC&#41; represents one of the types of inflammatory bowel disease&#44; which occurs in genetically predisposed individuals&#46; The coexistence of these two diseases is an unexpected condition&#46; Lately&#44; case reports have been published documenting the development of nephropathy after treatment of ulcerative colitis with mesalamine or sulphasalazine&#46; In cases in the literature&#44; this coexistence has been identified as associated with 5-ASA therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;5</span></a> In this case&#44; we report the ulcerative colitis occurring in a patient with focal segmental glomerulosclerosis not affiliated with 5-ASA therapy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 66-year-old man&#44; with a 3-year history of focal segmental glomerulosclerosis&#44; was admitted with bloody and mucoid diarrhea which had been for lasting for 10 days&#46; There was no fever&#44; nausea&#44; vomiting or infection&#46; There was no feature in the patient&#39;s history except diarrhea&#46; Physical examination also was normal&#46; Laboratory investigation demonstrated impaired renal function and proteinuria due to focal segmental glomerulosclerosis&#46; Renal function test which is similar to the old values showed serum creatinine level of 3&#46;15<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#46;8&#8211;1&#46;3&#41;&#44; BUN level of 89<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;17&#8211;43&#41; and 24-h urine protein level of 1876<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#40;&#60;200&#41;&#46; In addition&#44; his erythrocyte sedimentation rate &#40;ESR&#41; was 79<span class="elsevierStyleHsp" style=""></span>mm&#47;h &#40;&#60;20&#41; and C-reactive protein &#40;CRP&#41; was 6&#46;66<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;&#60;0&#46;4&#41;&#46; A large amount of leukocytes and erythrocytes was seen in the stool microscopy&#46; Stool cultures were detected negative twice&#46; Colonoscopy revealed that there were to exudates of millimetric ulcers descending colon&#44; sigmoid colon and rectum&#46; The colon biopsy confirmed the diagnosis of ulcerative colitis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was started on mesalamine&#46; His symptoms showed marked improvements after starting mesalamine treatment&#46; After treatment&#44; laboratory investigation demonstrated&#59; creatinine level of 3&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#46;8&#8211;1&#46;3&#41;&#44; BUN level of 116<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;17&#8211;43&#41;&#44; ESR level of 38<span class="elsevierStyleHsp" style=""></span>mm&#47;h &#40;&#60;20&#41;&#44; CRP level of 0&#46;319<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;&#60;0&#46;4&#41;&#44; and 24-h urine protein level of 2099<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#40;&#60;200&#41;&#46; There were no abnormalities suggestive of nephrotoxicity in patients due to mesalamine&#44; while acute phase reactants declined&#46; The decline in ESR and CRP levels is thought to be in favor of improving ulcerative colitis activation&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A focal segmental glomerulosclerosis after ulcerative colitis treatment with mesalamine and sulfasalazine has been reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Additionally in the literature&#44; there have been several minimal changes in the disease following the treatment of inflammatory bowel disease with mesalamine or sulfasalazine&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#8211;6</span></a> A case report has been published of nephrotic syndrome due to Crohn&#39;s disease with mesalamine treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this case&#44; we discuss about the developed ulcerative colitis in a patient who was followed for focal segmental glomerulosclerosis&#46; Unlike previously reported cases&#44; mesalamine and sulfasalazine have no effect on the togetherness of the two diseases&#46; Although primary and secondary FSGS forms are defined based on the underlying cause&#44; the podocyte damage is a common result eventually&#46; Some genetic factors affect the inflammation which is the main cause of development of the ulcerative colitis&#46; An unknown cause such as genetic&#44; environmental or infections except drugs may be factors in the etiology of these two diseases&#46; Furthermore&#44; an unknown cause can facilitate the development of nephrotoxicity after mesalamine and&#47;or sulfasalazine treatment&#46; In our case&#44; the patient&#39;s renal function did not change significantly after mesalamine treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The coexistence of ulcerative colitis and focal segmental glomerulosclerosis is a rare condition&#46; Mesalamine and&#47;or sulfasalazine which have been used in ulcerative colitis treatment may be nephrotoxic&#46; In our case&#44; we have detected togetherness between ulcerative colitis and non-drug-induced focal segmental glomerulosclerosis&#46; It should be kept in mind that the two diseases may be caused by an unknown factor such as genetic&#44; environmental or infections except drugs&#46;</p></span>"
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ISSN: 20132514
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