SFS144F1: Patient's renal function outcome.

Mentions: Symptomatic and anti-proteinuric treatments, including furosemide, enalapril, statin and aspirin, were initially prescribed, leading to symptomatic improvement but renal function parameters worsened [serum creatinine 123 µmol/L (1.4 mg/dL), proteinuria 10 g/24 h]. Enalapril was increased to the maximum tolerated dose (up to 40 mg/day), without benefit. Then Ponticelli's [1] therapy regimen, including steroids and chlorambucil, was started. One month later (at the end of the first course of steroids and before starting chlorambucil), the patient was admitted for gastrointestinal bleeding and worsening of renal function [serum creatinine 158 µmol/L (1.8 mg/dL)]. An endoscopy showed a large leiomyomatous mass with central ulceration in the posterior gastric wall. A partial gastrectomy with complete tumour removal was carried out after clinical stabilization. The histological study revealed features of a gastric stromal tumour. The patient did not receive complementary chemotherapy. After surgery, proteinuria decreased (down to 2.3 g/24 h) and the renal function normalized [serum creatinine 88 µmol/L (1.0 mg/dL)]. Three months after discharge (Figure 1), the nephropathy was in complete remission and the patient was only on a low dose of enalapril (5 mg/day).Fig. 1