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Do we have to perform a renal biopsy? Clinical dilemmas in a case with nephrotic syndrome.

Akimoto T, Otani N, Takeshima E, Saito O, Kusano E, Nagata D - Clin Med Insights Case Rep (2014)

Bottom Line: A morphological analysis of the kidney may also be of value for the overall management of patients with diabetic nephropathy.In this report, we would like to describe our serendipitous experience with a male type 2 diabetic patient presenting with nephrotic syndrome complicated by concurrent gastric carcinoma.We also discuss several conundrums that arose in the current case, which had an impact on our diagnostic and therapeutic decisions.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.

ABSTRACT
Renal biopsy is one of the pivotal diagnostic tools used in the field of nephrology. A morphological analysis of the kidney may also be of value for the overall management of patients with diabetic nephropathy. However, the indications for renal biopsy differ considerably among nephrologists, and no global consensus regarding performing this procedure among diabetic patients with various renal manifestations has yet been achieved. In this report, we would like to describe our serendipitous experience with a male type 2 diabetic patient presenting with nephrotic syndrome complicated by concurrent gastric carcinoma. We also discuss several conundrums that arose in the current case, which had an impact on our diagnostic and therapeutic decisions.

No MeSH data available.


Related in: MedlinePlus

A photomicrograph of the EMR specimen. A type 0–IIc lesion with a well-differentiated adenocarcinoma with negative lymphovascular involvement was found (hematoxylin and eosin stain). The scale bar is indicated.
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f1-ccrep-7-2014-067: A photomicrograph of the EMR specimen. A type 0–IIc lesion with a well-differentiated adenocarcinoma with negative lymphovascular involvement was found (hematoxylin and eosin stain). The scale bar is indicated.

Mentions: His physical examination at the referral was unremarkable except for periorbital and leg edema. The laboratory data obtained on admission are summarized in Table 1. Tests for hepatitis B virus surface antigens and antibodies to the hepatitis C virus were negative. Renal sonography showed that the renal dimensions of the right kidney measured 113 × 60 mm, while those of the left kidney measured 115 × 66 mm, and the degree of renal cortex echogenicity was normal. The patient’s urine was 3+ for protein and contained 8.9 g of protein in a 24 hour specimen. His proteinuria selectivity index and creatinine clearance were 0.325 and 78.8 mL/minute, respectively. An ophthalmologic analysis revealed the patient to have simple diabetic retinopathy. On the other hand, the latex-agglutination test for fecal occult blood was positive (124 ng/mL) despite the absence of remarkable findings in the diagnostic thoracoabdominal computed tomography scan, and thus, endoscopic analyses of the upper and lower gastrointestinal tracts were performed. The presence of sigmoid colon polyps, which consisted of adenomatous tissue, was confirmed, while the gastric biopsy specimens revealed the presence of a well-differentiated adenocarcinoma confined to the submucosa. Endoscopic mucosal resection (EMR) was finally performed three months after the referral, confirming that the neoplastic tissue was of type 0–IIc based on the Paris endoscopic classification of superficial neoplastic lesions,3 with a well-differentiated adenocarcinoma (Fig. 1), 7 × 6 mm in size. Eight months after the EMR, he was negative at occult fecal blood test but continued to exhibit nephrotic syndrome with a urine protein level of 3.69 g/g · Cr, an sAlb of 2.7 g/dL, and an sCr level of 2.04 mg/dL, and he was thus subjected to a pathological evaluation.


Do we have to perform a renal biopsy? Clinical dilemmas in a case with nephrotic syndrome.

Akimoto T, Otani N, Takeshima E, Saito O, Kusano E, Nagata D - Clin Med Insights Case Rep (2014)

A photomicrograph of the EMR specimen. A type 0–IIc lesion with a well-differentiated adenocarcinoma with negative lymphovascular involvement was found (hematoxylin and eosin stain). The scale bar is indicated.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4125421&req=5

f1-ccrep-7-2014-067: A photomicrograph of the EMR specimen. A type 0–IIc lesion with a well-differentiated adenocarcinoma with negative lymphovascular involvement was found (hematoxylin and eosin stain). The scale bar is indicated.
Mentions: His physical examination at the referral was unremarkable except for periorbital and leg edema. The laboratory data obtained on admission are summarized in Table 1. Tests for hepatitis B virus surface antigens and antibodies to the hepatitis C virus were negative. Renal sonography showed that the renal dimensions of the right kidney measured 113 × 60 mm, while those of the left kidney measured 115 × 66 mm, and the degree of renal cortex echogenicity was normal. The patient’s urine was 3+ for protein and contained 8.9 g of protein in a 24 hour specimen. His proteinuria selectivity index and creatinine clearance were 0.325 and 78.8 mL/minute, respectively. An ophthalmologic analysis revealed the patient to have simple diabetic retinopathy. On the other hand, the latex-agglutination test for fecal occult blood was positive (124 ng/mL) despite the absence of remarkable findings in the diagnostic thoracoabdominal computed tomography scan, and thus, endoscopic analyses of the upper and lower gastrointestinal tracts were performed. The presence of sigmoid colon polyps, which consisted of adenomatous tissue, was confirmed, while the gastric biopsy specimens revealed the presence of a well-differentiated adenocarcinoma confined to the submucosa. Endoscopic mucosal resection (EMR) was finally performed three months after the referral, confirming that the neoplastic tissue was of type 0–IIc based on the Paris endoscopic classification of superficial neoplastic lesions,3 with a well-differentiated adenocarcinoma (Fig. 1), 7 × 6 mm in size. Eight months after the EMR, he was negative at occult fecal blood test but continued to exhibit nephrotic syndrome with a urine protein level of 3.69 g/g · Cr, an sAlb of 2.7 g/dL, and an sCr level of 2.04 mg/dL, and he was thus subjected to a pathological evaluation.

Bottom Line: A morphological analysis of the kidney may also be of value for the overall management of patients with diabetic nephropathy.In this report, we would like to describe our serendipitous experience with a male type 2 diabetic patient presenting with nephrotic syndrome complicated by concurrent gastric carcinoma.We also discuss several conundrums that arose in the current case, which had an impact on our diagnostic and therapeutic decisions.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.

ABSTRACT
Renal biopsy is one of the pivotal diagnostic tools used in the field of nephrology. A morphological analysis of the kidney may also be of value for the overall management of patients with diabetic nephropathy. However, the indications for renal biopsy differ considerably among nephrologists, and no global consensus regarding performing this procedure among diabetic patients with various renal manifestations has yet been achieved. In this report, we would like to describe our serendipitous experience with a male type 2 diabetic patient presenting with nephrotic syndrome complicated by concurrent gastric carcinoma. We also discuss several conundrums that arose in the current case, which had an impact on our diagnostic and therapeutic decisions.

No MeSH data available.


Related in: MedlinePlus