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Nephroquiz
(Section Editor: M. G. Zeier)
A dry mouth and oedematous ankle
1 Department of Rheumatology and Clinical Immunology2 Department of Pathology3 Department of Haematology4 Department of Nephrology University Medical Centre Utrecht PO Box 85500 3508 GA Utrecht The Netherlands
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A 59-year-old woman, suffering from primary Sjögren's syndrome (pSS) since the age of 48, was treated symptomatically. In 2003 a marginal zone B-cell lymphoma was diagnosed, localized in the mediastinum, producing IgM
paraproteins. This type of lymphoma is a low grade lymphoma and observation without treatment is legitimate.
In August 2004 she experienced ankle oedema and foamy urine. Physical examination revealed hypertension (170/95 mmHg) and peripheral leg oedema. Laboratory data showed: haemoglobin 7.3 mmol/l, white cell count 7.3x109/l, thrombocytes 603x109/l, serum sodium 133 mmol/l, potassium 4.6 mmol/l, serum
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Primary Sjögren's syndrome and kidney involvement [1,2]
Primary Sjögren's syndrome and lymphoma [5]