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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

The renal biopsy findings. (A) A low power view showing the diffuse distribution of glomeruli with various stages of diabetic glomerular injuries, including glomeruli with hyalinotic lesions (narrow arrow), a moderate increase in mesangial matrix and thickening of the capillary wall (medium arrow), as well as nodule formation (wide arrows) (periodic acid-Schiff stain). Two sections of the same glomerulus with nodular lesions (B) and enormous exudative lesions with some bubbles, probably representing plasma proteins/lipids (C) (upper panel, periodic acid-Schiff stain; lower panel, periodic acid methenamine silver-Masson trichrome stain). The scale bar is indicated in each panel.
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f2-ccrep-7-2014-067: The renal biopsy findings. (A) A low power view showing the diffuse distribution of glomeruli with various stages of diabetic glomerular injuries, including glomeruli with hyalinotic lesions (narrow arrow), a moderate increase in mesangial matrix and thickening of the capillary wall (medium arrow), as well as nodule formation (wide arrows) (periodic acid-Schiff stain). Two sections of the same glomerulus with nodular lesions (B) and enormous exudative lesions with some bubbles, probably representing plasma proteins/lipids (C) (upper panel, periodic acid-Schiff stain; lower panel, periodic acid methenamine silver-Masson trichrome stain). The scale bar is indicated in each panel.

Mentions: The renal biopsy consisted of three cores of renal parenchyma with 32 glomeruli, almost half of which were globally sclerotic. There were glomeruli with hyalinotic lesions, globally widened mesangial regions, and a number of rounded acellular mesangial nodules; and also interstitial infiltration of lymphocytes, atrophic changes in the tubule structure, interstitial fibrosis, and arteriolar hyalinization were identified (Fig. 2). Immunofluorescence staining failed to demonstrate the linear staining of IgG along the glomerular capillary wall. Instead, the presence of focal deposits of IgM in the depending portions of the areas of hyalinosis was confirmed. Electron microscopy failed to show the presence of electron-dense deposits on the subepithelium of the glomerular basement membrane, which is a suggestive finding of membranous nephropathy.4


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)

The renal biopsy findings. (A) A low power view showing the diffuse distribution of glomeruli with various stages of diabetic glomerular injuries, including glomeruli with hyalinotic lesions (narrow arrow), a moderate increase in mesangial matrix and thickening of the capillary wall (medium arrow), as well as nodule formation (wide arrows) (periodic acid-Schiff stain). Two sections of the same glomerulus with nodular lesions (B) and enormous exudative lesions with some bubbles, probably representing plasma proteins/lipids (C) (upper panel, periodic acid-Schiff stain; lower panel, periodic acid methenamine silver-Masson trichrome stain). The scale bar is indicated in each panel.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2-ccrep-7-2014-067: The renal biopsy findings. (A) A low power view showing the diffuse distribution of glomeruli with various stages of diabetic glomerular injuries, including glomeruli with hyalinotic lesions (narrow arrow), a moderate increase in mesangial matrix and thickening of the capillary wall (medium arrow), as well as nodule formation (wide arrows) (periodic acid-Schiff stain). Two sections of the same glomerulus with nodular lesions (B) and enormous exudative lesions with some bubbles, probably representing plasma proteins/lipids (C) (upper panel, periodic acid-Schiff stain; lower panel, periodic acid methenamine silver-Masson trichrome stain). The scale bar is indicated in each panel.
Mentions: The renal biopsy consisted of three cores of renal parenchyma with 32 glomeruli, almost half of which were globally sclerotic. There were glomeruli with hyalinotic lesions, globally widened mesangial regions, and a number of rounded acellular mesangial nodules; and also interstitial infiltration of lymphocytes, atrophic changes in the tubule structure, interstitial fibrosis, and arteriolar hyalinization were identified (Fig. 2). Immunofluorescence staining failed to demonstrate the linear staining of IgG along the glomerular capillary wall. Instead, the presence of focal deposits of IgM in the depending portions of the areas of hyalinosis was confirmed. Electron microscopy failed to show the presence of electron-dense deposits on the subepithelium of the glomerular basement membrane, which is a suggestive finding of membranous nephropathy.4

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