Paroxysmal nocturnal haemoglobinuria with renal, infective and immunological abnormalities.

Introduction Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disease characterized by a membrane abnormality of red cells leading to episodic haemolysis. It has only occasionally been observed in the elderly (Sirchia and Lewis, 1975). The rarity of the disease, the insidious development of symptoms and variety of presentations mean that diagnosis may be incorrect or delayed (Polli et al., 1973). PNH is associated with an increased incidence of infection particularly of the renal tract (Sirchia and Lewis, 1975). Renal impairment in PNH is usually attributed to chronic pyelonephritis. However, reversible acute renal failure in PNH has been reported and intense haemoglobinuria was thought to be the cause (Rubin, 1971). A case is described of a woman who first reported symptoms at the age of 85 years and who subsequently developed renal failure which was almost completely reversible. She had evidence of infective and thrombotic complications associated with this disease and showed an immunological abnormality not previously associated with PNH.