Nephrotic syndrome in a bee keeper: rediscovery of an extinct disease?

An elderly beekeeper presented with nephrotic syndrome due to secondary amyloidosis. He developed progressive renal impairment and ultimately required dialysis. The patient had received multiple bee stings per day over seven decades without any allergic reactions. Here, we report secondary amyloidosis associated with recurrent bee venom exposure. KeyworDs Bee sting, kidney, nephrotic, secondary amyloidosis, venom DeClaration of interests No conflict of interests declared. Image of the quarter 1TF Hiemstra, 2KGC Smith, 3DV Hamilton 1Research Fellow and Honorary Specialist Registrar; 2Genzyme Professor of Experimental Medicine, Cambridge Institute for Medical Research, Cambridge; 3Consultant Physician and Nephrologist, Jack Pryor Renal Unit, Norfolk and Norwich University Hospital, Norwich, UK Published online January 2009 Correspondence to TF Hiemstra, Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Box 139, Addenbrookes Hospital, Cambridge CB2 0XY, UK tel. +44 (0)1223 331756 e-mail [email protected] Figure 1 Renal biopsy from an elderly beekeeper presenting with a nephrotic syndrome due to secondary amyloidosis which progressed to renal impairment, ultimately requiring dialysis. (A) Haematoxylin and eosin stain showing marked and uniform eosinophilic thickening of glomerular capillary walls (arrow). (B) Congo red stain demonstrating a glomerulus with some sclerosis and amyloid deposition in capillary walls (arrow). There was insufficient tissue to perform immunofluorescence. a