Case Of Membranous Glomerulonephritis Research Articles

Immunohistochemical Analysis of Glomerular Phospholipase A2 Receptor in Primary and Secondary Membranous Glomerulonephritis

Background: A common cause of adult nephrotic syndrome (NS) is membranous glomerulonephritis (MGN). The larger portion of MGN in adults is the idiopathic/ primary MGN (iMGN). So many conditions like autoimmunity, malignant tumor, drugs and infections can cause a secondary form of MGN. We can diagnose primary/ idiopathic MGN after the omission of all known secondary causes. As we know M-type phospholipase A2 receptor (PLA2R) on podocytes is the target antigen in the pathogenesis of primary MGN. Phospholipase A2 receptor (PLA2R) can be detected by immunohistochemically. Differences between primary MGN (iMGN) and secondary MGN are essential because of treatment implications. Objective: To evaluate the histopathological pattern of MGN and to correlate with PLA2R deposition in primary and secondary MGN in a group of Bangladeshi people. Methods: The research method is descriptive cross- sectional and observational. The study population was 60 patients in the department of Histopathology, AFIP, Dhaka Cantonment, Dhaka for duration of six months period from January 2019 to June 2019. At first, adequate clinical information was taken and categorized as primary and secondary MGN on a clinical basis, thereafter immuno- histochemistry of anti-PLA2R was done from formalin-fixed paraffin block of those cases. Results: A total of 60 diagnosed cases of MGN, 56 patients were found primary, and 04 were secondary based on clinical data. In my study, all primary MGN was found as PLA2R positive. Conclusion: The present study exhibits that immuno- histochemistry with anti-PLA2R antibodies can be the best diagnostic method for diagnosis of idiopathic MGN which offers an opportunity for personalized medicine. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 24-28

Application of direct stochastic optical reconstruction microscopy (dSTORM) to the histological analysis of human glomerular disease.

Electron microscopy (EM) following immunofluorescence (IF) imaging is a vital tool for the diagnosis of human glomerular diseases, but the implementation of EM is limited to specialised institutions and it is not available in many countries. Recent progress in fluorescence microscopy now enables conventional widefield fluorescence microscopes to be adapted at modest cost to provide resolution below 50 nm in biological specimens. We show that stochastically switched single‐molecule localisation microscopy can be applied to clinical histological sections stained with standard IF techniques and that such super‐resolved IF may provide an alternative means to resolve ultrastructure to aid the diagnosis of kidney disease where EM is not available. We have implemented the direct stochastic optical reconstruction microscopy technique with human kidney biopsy frozen sections stained with clinically approved immunofluorescent probes for the basal laminae and immunoglobulin G deposits. Using cases of membranous glomerulonephritis, thin basement membrane lesion, and lupus nephritis, we compare this approach to clinical EM images and demonstrate enhanced imaging compared to conventional IF microscopy. With minor modifications in established IF protocols of clinical frozen renal biopsies, we believe the cost‐effective adaptation of conventional widefield microscopes can be widely implemented to provide super‐resolved image information to aid diagnosis of human glomerular disease.

Detection of Phospholipase A2 Receptor Related Membranous Nephropathy in Membranous Nephropathy Patient

Background: Membranous glomerulonephritis (MGN) considered as the most common causes ofnephrotic syndrome (NS) in the world. Eighty percent of cases are classified as primary MGN. PrimaryMGN is an autoimmune disease in which autoantibodies against podocyte antigens forming subepithelialimmune deposits and result in NS. Autoantibodies against M-type phospholipase A2 receptor (PLA2R)were found in 70-80% of patients with primary MGN but not in those with secondary MGN or other renaldiseases. So, we aim to identify PLA2R associated primary MGN.Patient and methods: Out of 5000 native biopsies received from 2014-17, 600 were diagnosed as MGN,out of which 62 were stained for anti-PLA2R by immunoperoxidase. Nine cases of Lupus (SLE) Class V,12 of hepatitis C&B Virus MGN (10 HCV+ve and 2 HBV+ve) were used as controls. Positive wasdetermined as diffuse glomerular capillary wall staining.Results: Anti-PLA2R was positive in 61%(38/62) of cases (33 idiopathic cases and 5 cases of the control group3:HCV, 1 HBV, 1 SLE). None of theclinical parameters showed significance difference but nephrotic range proteinuria in the anti-PLA2R +vegroup was more (66% vs 46%). Histologically, onlymesangial matrix expansion was significantlydifferent in the aPLA2R –ve group (33% vs 10%, p=0.04).Conclusion: anti-PLA2R tissue staining is a reliable and specific method to identify primary MGN andshould be done routinely in all MGN cases even those identified as secondary on clinical basis.

Validation of phospholipase A2 receptor direct immunofluorescence staining in the diagnosis of primary membranous glomerulonephritis

Distinguishing between primary and secondary subtypes of membranous glomerulonephritis (MGN) is critical for its clinical management. We prospectively compared direct immunofluorescence (DIF) staining for phospholipase A2 receptor (PLA2R) on frozen renal biopsy with the presence of detectable serum PLA2R antibody assessed by enzyme linked immunosorbent assay (ELISA) in the diagnosis of primary MGN. Forty-six patients with biopsy-proven MGN were enrolled from April 2017 to June 2019 with 31/46 (67.4%) being primary and 15/46 (32.6%) being secondary as determined by comprehensive clinical assessment. This is currently deemed to be the gold standard for distinguishing primary from secondary MGN. Amongst the 31 primary MGN patients, 24/31 were positive on PLA2R DIF staining compared to 18/31 being positive on the PLA2R ELISA (p=0.03). Amongst the 15 secondary MGN patients, 1/15 was positive on PLA2R DIF compared to 0/15 on PLA2R ELISA (p=1.0). In conclusion, the presence of PLA2R staining on DIF demonstrated superior sensitivity and similar specificity compared to the detection of circulating PLA2R antibodies by ELISA in the diagnosis of primary MGN in a cohort of 46 patients with biopsy-proven MGN. We suggest that DIF should be considered as part of routine work-up in all newly diagnosed cases of MGN.

Clinicopathological study of nephrotic syndrome in Indian children :A tertiary care experience

Background: Nephrotic syndrome is an important chronic disorder in children with clinical manifestation of different histopathological subtypes. An aim of the study was to determine incidence of renal biopsy in paediatric nephrotic syndrome, correlations between the clinical and histomorphological patterns in Indian ethnicity children at our tertiary care institute. Methods: : A retrospective study of kidney biopsies with, immunofluorescence and electron microscopy with clinical outcome of the children with nephrotic syndrome was done over a period of 15 years. Biopsies were stained with Hematoxylin & eosin, Periodic acid Schiff and silver impregnation stain and also processed for immunofluorescence and electron microscopy as necessary. All renal biopsy findings were correlated with clinical response to steroid therapy, immunosuppressant, and clinical parameters. Result: Frequencies in results were calculated by Chi square test for categorical variables. Mann-Whitney U test was used for non parametric variables. Predominantly cases were seen in the age group 8-12 years. Atypical nephrotic syndrome was the commonest presenting feature followed by steroid resistant nephrotic syndrome. Minimal change disease was the commonest histomorphological pattern followed by focal segmental glomerular sclerosis. All the cases of membranous glomerulonephritis in study were secondary in nature. Light microscopy findings correlated with electron microscopy, in 80.95% cases. Conclusion: Minimal change disease occurs up to 6 times more commonly in Indian children than in Europian counterpart, but rise in FSGS cases as a cause for nephrotic syndrome is now being encountered. In India the proportion of cases with Membrano-proliferative glomerulonephritis is high, attributable to the high prevalence of infectious diseases like tuberculosis, chronic suppurative infections and malnutrition. DOI: 10.21276/apalm.2017.995

Unmasking of complements using proteinase-K in formalin fixed paraffin embedded renal biopsies.

Renal biopsy interpretation requires histopathology, direct immunofluorescence (DIF) and electron microscopy. Formalin-fixed, paraffin-embedded tissue (FFPE) sent for light microscopy can be used for DIF after antigen retrieval. However, complement staining has not been satisfactory. We standardized DIF using proteinase-K for antigen retrieval in FFPE renal biopsies. A pilot study was conducted on known cases of membranous glomerulonephritis (MGN), membranoproliferative type-1 (MPGN-1), immunoglobulin A nephropathy (IgAN), and anti-glomerular basement disease (anti-GBM). Immunofluorescence panel included fluorescein isothiocyanate (FITC) conjugated IgG, IgA, IgM, complements (C3 and C1q), light chains (kappa, lambda) and fibrinogen antibodies. After standardization of the technique, 75 renal biopsies and 43 autopsies cases were stained. Out of 43 autopsy cases, immune-complex mediated glomerulonephritis (GN) was confirmed in 18 cases (Lupus nephritis-11, IgAN-6, MGN-1), complement-mediated dense deposit disease (DDD-1) and monoclonal diseases in 4 cases (amyloidosis-3, cast nephropathy-1). Immune-mediated injury was excluded in 17 cases (focal segmental glomerulosclerosis -3, crescentic GN-6 [pauci-immune-3, anti-GBM-3], thrombotic microangiopathy-5, atherosclerosis-3). Renal biopsies (n-75) where inadequate or no frozen sample was available; this technique classified 52 mesangiocapillary pattern as MPGN type-1-46, DDD-2 and (C3GN-4). Others were diagnosed as IgAN-3, lupus nephritis-2, MGN-4, diffuse proliferative glomerulonephritis (DPGN)-1, Non-IC crescentic GN-1, monoclonal diseases-3. In nine cases, DIF on FFPE tissue could not help in making diagnosis. Proteinase-K enzymatic digestion of FFPE renal biopsies can unmask complements (both C3 and C1q) in immune-complexes mediated and complement-mediated diseases. This method showed good results on autopsy tissues archived for as long as 15 years.

P3-24: Secondary hypertension in a tunisian internal medicine department

Secondary hypertension (SH) refers to arterial hypertension due to an identifiable and often curable cause. It affects approximately 5-10% of the general hypertensive population. SH can be caused by conditions that affect kidneys, arteries, heart or endocrine system. Our aim is to describe the different causes of SH noted in our patients. It is a retrospective study of 240 patients followed for a SH at the Internal Medicine Department of the Tunisian Military Hospital from 2000 to 2015. The diagnosis of SH in these patients was suspected in front of clinical and biological arguments and confirmed by the further explorations guiding a suitable therapeutic attitude. Renal causes were the main etiology of SH (233 patients) with acute glomerular nephritis (AGN) in 4 cases, primary chronic glomerular nephropathy (CGN) in 14 cases, including 8 cases of membranous glomerulonephritis, 2 cases of focal segmental glomerulosclerosis and 4 cases of membrano-proliferative glomerulonephritis. Secondary CGN were dominated by diabetic nephropathy in 174 cases, lupus nephropathy in 10 cases and rheumatoid purpura in one case. Congenital kidney diseases were represented by hereditary polycystic kidney disease in 20 patients and Alport syndrome in 2 patients. The renovascular hypertension was noted in 8 cases. The endocrine causes were present in 6 patients (2 cases of Conn syndrome, 2 cases of hyperthyroidism, 1 case of bilateral adrenal hyperplasia and another case of pheochromocytoma). One patient had SH with a cardiac cause that was aortic coarctation. The prevalence of SH exceeds 30% among patients with resistant hypertension. Common causes include chronic kidney diseases, primary aldosteronism, renovascular hypertension and obstructive sleep apnea. In our study, renal parenchymal disease particularly diabetes is the most common cause of SH. Physicians should be judicious about evaluation of a potentially curable cause of hypertension. Careful clinical evaluation and simple algorithms help avoid unnecessary investigations. In patients with SH, early detection and treatment are important to minimize and prevent irreversible changes in the vasculature and target organs.

“Nephrotic Syndrome Associated with Breast Cancer; When should it be treated?

We hereby describe a 46-year woman with nephrotic syndrome and new-onset breast cancer. This patient admitted to our hospital with peripheral edema and a mass in her right breast. Membranous glomerulonephritis (MGN) was the etiology of nephrotic syndrome. MGN has been reported in association with a wide variety of solid neoplastic diseases, although rarely occurs as a complication of breast carcinoma. We report a rare and a resistant case of MGN, who was concomitant diagnosed with breast cancer and there was no improvement in proteinuria although breast cancer was under-controlled with cheomotheraphy and surgery.

The Clinicopathologic Significance of Endothelial Tubuloreticular Inclusions in Glomerular Diseases

Background: The presence of tubuloreticular inclusions (TRIs) in endothelial cells (ECs) always evokes suspicion of an association with underlying viral infections or autoimmune diseases. However, other underlying diseases can be associated with TRI expression. Since identification of the underlying disease is of primary consideration for management of glomerulonephritis (GN), it is important to clarify the clinical significance of TRI expression.Methods: The authors studied 104 renal biopsy cases having TRI. They investigated their clinicopathological profiles and focused on potential connections with underlying diseases.Results: Among 104 renal biopsy cases, 62 cases (59.6%) were associated with lupus nephritis (LN) and 20 cases (19.2%) were associated with a viral infection (hepatitis B virus (13), hepatits C virus (4), and human immunodeficiency virus (3)). Other underlying disease groups included membranous GN (MGN) (7), IgA nephropathy (7), Henoch-Schoenlein purpura (HSP) nephritis (2), and others (6). The incidence of TRIs in both LN and viral infections was significantly higher than for other diseases (p < 0.0001). Among 7 MGN cases, 2 cases were diabetes, 1 case was associated with lung cancer, another case with antineutrophilic cytoplasmic antibody (ANCA), and the others showed no evidence of systemic disease. On immunofluorescence (IF) study, 2 MGN cases, 2 IgA nephropathy cases, and 1 HSP nephritis case showed C1q deposition, with no evidence of SLE.Conclusions: TRIs were identified in MGN and other glomerular diseases, including IgA nephropathy and HSP nephritis. However, a diagnosis of LN should be considered because TRIs associated with a full-house IF pattern are usually found in LN.

Membranous glomerulonephritis associated with splenic marginal zone lymphoma mimicking multiple myeloma

Glomerulonephritis may complicate the course of a wide variety of malignant diseases. However, there are relatively few reports of membranous glomerulonephritis (MGN) in patients with non-Hodgkin lymphoma (NHL). We describe for the first time a case of MGN associated with splenic marginal zone lymphoma with extreme plasmacytic differentiation and bone marrow infiltration mimicking multiple myeloma. We also reviewed the literature and summarize the clinical-pathological findings and the mechanisms involved in NHL-induced MGN. Our current case highlights the importance of a quick and correct diagnosis of the underlying disease and the value of a thorough physical examination. Clinicians should be aware of the possibility of an underlying hematologic malignancy in such cases, particularly in elderly patients with renal biopsy that shows the presence of atypical histology.

Membranous glomerulonephritis is a manifestation of IgG4-related disease

IgG4-related disease (IgG4-RD) is a systemic immune-mediated disease that typically manifests as fibro-inflammatory masses that can affect nearly any organ system. Renal involvement by IgG4-RD usually takes the form of IgG4-related tubulointerstitial nephritis, but cases of membranous glomerulonephritis (MGN) have also been described. Here we present a series of 9 patients (mean age at diagnosis 58 years) with MGN associated with IgG4-RD. All patients showed MGN on biopsy, presented with proteinuria (mean 8.3 g/day), and most had elevated serum creatinine (mean 2.2 mg/dl). Seven patients had known extrarenal involvement by IgG4-RD, with 5 patients having concurrent IgG4-related tubulointerstitial nephritis. Immunohistochemical analysis for the phospholipase A2 receptor, a marker of primary MGN, was negative in all 8 biopsies so examined. Six of 7 patients with available follow-up (mean 39 months) were treated with immunosuppressive agents; one untreated patient developed end-stage renal disease and underwent transplantation, without recurrence at 12 years after transplant. All 6 treated patients showed decreased proteinuria (mean 1.2 g/day), and most showed decreased serum creatinine (mean 1.4 mg/dl). Thus, MGN should be included in the spectrum of IgG4-RD and should be suspected in proteinuric IgG4-RD patients. Conversely, patients with MGN and an appropriate clinical history should be evaluated for IgG4-RD.

A patient with HIV infection presenting with diffuse membranous glomerulonephritis in a country with a low HIV prevalence—Remarkable remission with therapy

The most common manifestation of HIV in the kidney is HIV-associated nephropathy (HIVAN). In this report, we describe the first documented case of membranous glomerulonephritis in an HIV-positive individual in Turkey, the country with the lowest HIV prevalence in the region. The case occurred in an HIV-positive, hepatitis C (HCV)-negative, and hepatitis B (HBV)-negative Caucasian male, who presented with nephrotic-range proteinuria. The patient had a favorable response to HAART and an angiotensin-receptor blocker.

Patterns of IgG Subclass Deposits in Membranous Glomerulonephritis in Renal Allografts

Background Membranous glomerulonephritis (MGN) may develop in the renal allograft either de novo or as a recurrence. These 2 forms of MGN may have different pathogenic mechanisms, with different IgG subclass profiles in the immune deposits. This study examined IgG subclass distributions in recurrent and de novo MGN in allograft kidneys. Methods We identified allograft kidneys with MGN, including 7 with recurrent MGN, 2 with de novo MGN, and 2 atypical/indeterminate, and determined the relative intensity of IgG1, IgG2, IgG3, and IgG4 staining in capillary wall deposits by immunofluorescence microscopy. Results IgG4 was the dominant or codominant IgG subclass in capillary loop deposits in all 7 cases of recurrent MGN. IgG1 staining was dominant in 3 of 4 de novo or atypical MGN cases and codominant with IgG4 in the fourth. Conclusions Although pretransplantation kidney biopsies were not available for comparisons, these findings suggest that all allograft recurrences represent idiopathic MGN and that de novo MGN cases had a different pathogenic mechanism.

Membranous Glomerulonephritis with the Use of Etanercept in Ankylosing Spondylitis

To report a case of membranous glomerulonephritis with the use of etanercept in a patient with ankylosing spondylitis. A 60-year-old female with severe ankylosing spondylitis and no history of renal disease was started on etanercept 50 mg subcutaneously once a week after standard treatment modalities failed. She had not been on any nephrotoxic drugs, including nonsteroidal antiinflammatory drugs, for over 1 year. After 2 months of etanercept therapy, the patient presented with anasarca, proteinuria, hypoalbuminemia, and normal serum creatinine. Renal biopsy showed features classic for membranous glomerulonephritis (MGN). Etanercept was discontinued, with resolution of anasarca and proteinuria over the following 3 months. Very few cases of MGN in patients with ankylosing spondylitis have been reported in the literature; additionally, MGN following etanercept therapy has not been described in patients with ankylosing spondylitis so far. The exact pathogenesis of etanercept-induced MGN in ankylosing spondylitis is not known. Tumor necrosis factor-α antagonists have been associated with the formation of autoantibodies and induction of lupus-like ailments in patients with rheumatoid arthritis. It is possible that a similar dysregulation of the immune system might have accounted for the development of MGN in this patient. The Naranjo probability scale showed that this patient's MGN was probably associated with etanercept therapy. In addition to the well-described serious adverse drug events, including serious infections, the use of etanercept in ankylosing spondylitis can be associated with the development of MGN. Health care providers, especially rheumatologists, should be aware of this potentially serious adverse drug reaction.

C4d immunohistochemical staining is a sensitive method to confirm immunoreactant deposition in formalin-fixed paraffin-embedded tissue in membranous glomerulonephritis.

Although the diagnosis of membranous glomerulonephritis (MGN) may be suspected on routine histology of formalin-fixed paraffin-embedded tissue, fresh-frozen tissue must be used to show the immunologic nature of the process by direct immunofluorescence (IF). The efficiency of IF or immunoperoxidase (IP) detection of IgG and C3 using paraffin sections is controversial. This study was designed to evaluate whether glomerular C4d deposition using an IP method in formalin-fixed paraffin-embedded tissue may be a useful marker for MGN. We showed characteristic glomerular, granular basement membrane deposition of C4d in 31 (100%) cases of idiopathic MGN and in 5 cases (100%) of pure class V membranous lupus nephritis, in which we had a positive diagnosis of the lesions for conventional IF study. Control cases were negative. Nineteen cases of different glomerulopathies, including IgA nephropathy, primary type I membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis and minimal change disease showed diverse reproducible patterns of C4d deposition, without intrinsic background. Our results indicate that staining of formalin-fixed paraffin-embedded tissue for C4d can be used for confirmation of granular basement membrane immunoreactant deposition in cases of MGN. This proved to be a reliable method that could potentially obviate the need for rebiopsy in cases with absence of glomeruli in renal frozen sections or when other adjunct IF or IP methods on paraffin sections are negative. C4d immunostaining, using an IP method, deserves a place as an adjunct method in the biopsy diagnosis of MGN.

In vivo characterization of renal auto‐antigens involved in human auto‐immune diseases: The case of membranous glomerulonephritis

Renal auto-immune diseases represent a major source of morbidity in humans. For many years the knowledge on mechanisms of auto-immunity involving the kidney has been uniquely based on animal models. However, these findings often could not be readily translated to humans owing to notably difference in antigen expression by human podocytes. One example is Heymann nephritis (HN), the experimental model of human membranous glomerulonephritis (MGN), which is obtained in rats by injecting antibodies against megalin, a protein that is not present in human glomeruli. Human studies could not be done in the past since sequencing required too much material exceeding what obtainable from tissue biopsies in vivo. Research is now on the way to identify auto-antigens and isolate specific auto-antibodies in humans. New technology developments based on tissue microdissection and proteomical analysis have facilitated the recent discoveries, allowing direct analysis of human tissue in vivo. Major advances on the pathogenesis of MGN, the prototype for the formation and glomerular deposition of auto-antibodies, are now in progress. Two independent groups have, in fact, demonstrated the existence of specific IgG(4) against phospholipase A2 receptor, aldose reductase and Mn-superoxide dismutase in glomerular eluates and in plasma of a prominent part of patients with MGN, suggesting a major role of these proteins as auto-antigens in human MGN. This review will focalize these aspects outlining the contribution of proteomics in most recent developments.

Renal glomerular alterations in patients with cancer: a clinical and immunohistochemical autopsy study

Background: Membranous glomerulonephritis (MGN) can be found in patients with cancer as a paraneoplastic syndrome or it could be manifested clinically before tumor detection. The aim of this study was to evaluate the frequency and type of renal histopathological alterations in patients with malignancy that died without cancer treatment and were submitted to necropsy. Methods: Patient's demographical and clinical data collection and laboratory tests (serum creatinine and urine sample) were evaluated. Results: Kidney fragments from 21 patients were obtained and studied by light microscopy after habitual staining. Immunohistochemistry studies were performed with monoclonal immunoglobulin and tumor markers. Patients' mean age was 71 years and 62% were male. The most frequent tumor was gastric cancer (five cases), followed by colon and oral cavity (three cases each). In 67% of the cases, malignancy was the main cause of death. Serum creatinine was increased in 10 cases, proteinuria in 15, and hematuria was present in 8 cases. The most usual glomerular lesion found was thickening of basement membrane (BM) of the capillary loops. There were two cases of IgA nephropathy, three cases of focal segmental glomerulosclerosis, and one case of MGN. Only in the patient with MGN and metastatic melanoma specific tumor markers were identified in the kidney. Conclusions: We observed a wide range of glomerular pathological changes and abnormal urinary sediments in almost all patients, but we found tumor marker deposits only in the patient with MGN.

Glomerular diseases in renal biopsy. Correlation of clinical syndromes with histological types

Renal biopsies studied by light and electron microscopy as well as by immunohistochemistry seem to be continually necessary for an adequate typing and therapy of glomerulonephritis (GN) and other glomerular diseases. Basing on 653 renal biopsies examined in Rostock from 1990 to 1999, the morphological classification in a total of 585 cases with glomerular diseases is presented in comparison to their clinical syndromes according to the WHO classification. A nephrotic syndrome was most frequent and clinically reported in 258 of the 585 biopsy cases with glomerular diseases (44%). It was seen in 77 of the 87 cases with minimal change nephropathy (55%), in 46 of the 74 cases with focal segmental glomerulosclerosis (62%), and in 19 of the 24 diffuse membranous GN cases (79%). The majority of the varying histological subtypes of diffuse GN was not combined with a specific clinical syndrome except of diffuse crescentic GN presenting with a rapidly progressive nephritic syndrome in 14 of 16 cases (88%). IgA nephropathy was the most often diagnosed entity of glomerular diseases found in 122 of the 502 cases with primary or secondary GN (24%). It is obvious that a given morphological GN type can but must not be combined with a specific clinical GN syndrome, so that the clinical importance of renal biopsy is stressed.

A Case of Membranous Glomerulonephritis Associated with Small Cell Lung Cancer Being Complete Remmission with Chemotherapy

Paraneoplastic nephrotic syndrome can be diagnosed from its clinical and immunological features. The development of several types of glomerular injury in patients with cancer have been recognized, and are considered as paraneoplastic syndrome. Most prominent are the occurrence of membranous glomerulonephritis in patients with carcinomas. We report a case of a 60-year-old-man with small cell lung cancer presenting as nephrotic syndrome. A renal biopsy revealed membranous glomerulonephritis. Six lots of chemotherapy were administered, which led to a complete tumor response with total resolution of the nephrotic syndrome following treatment.

Lupic nephropathy in childhood: morphologic analysis of 18 cases

The present study describes 21 cases (17 females and 01 male) of 12 year old patients, or younger, with diagnosis of SLE, that were submitted to renal biopsy. The histologic study demonstrated 10 cases of membranoproliferative glomerulonephritis (Class IV-WHO); 4 cases of focal proliferative glomerulonephritis (Class III-WHO; 2 cases of mesangial proliferative glomerulonephritis (Class II-WHO) and 2 cases of membranous glomerulonephritis (Class V-WHO). Three cases were excluded. In this study the incidence of lupus nephritis in children was small, similar to what has been described by other authors, and presenting unfavorable histologic patterns.