[aktorque]

A 56-year-old Caucasian male who was recently diagnosed with colon cancer suffers from generalized edema. Urine protein excretion is 4.5g over 24 hours. Kidney biopsy shows glomerular capillary wall thickening without an increase in cellularity. When the sample is stained with silver methenamine, irregular spikes protruding from glomerular basement membrane are seen. This patient most likely suffers from which of the following?


A. Anti-SBM disease
B. ANCA-associated glomerulonephritis
C. Membranous glomerulopathy
D. Membranoproliferative glomerulonephritis
E. Postinfectious glomerulonephritis
F. Berger disease
G. Focal segmental glomerulosclerosis
H. Minimal change disease
I. Alport syndrome
J. Thin basement membrane syndrome
K. Amyloidosis
L. Multiple myeloma
M. Malignant hypertension

 

[drahmednawaz]

Answer is C.

Nephrotic Syndrome caused by membranous glumerolopathy. Most cases are idiopathic, some are caused by drugs such as pencillamine, gold,; some by neoplasms such as lymphoma, colon cancer.....

 

[1TA2B]

C

Membranous GN is the commonest glomerular lesion associated with carcinomas, comprising 70%.

 

[kiyawat]

c. membranous glomerulonephritis

spike like lesions of glomerular basement membrane and also the carcinoma association can be the supporting points i guess

 

[ms.med]

C- membranous

Subepithelial spikes seen,
it is also the MC nephrotic (3.5+ proteinuria) seen in malignancy & adults

 

[aktorque]

C) Membranous glomerulopathy

Correct ans is C) Membranous glomerulopathy

click image to enlarge

This patient has a nephrotic syndrome, characterized by generalized edema and marked proteinuria (>3.5 g/day). Membranous glomerulopathy is the second most common cause of nephrotic syndrome in adults. (The most common cause is focal segmental glomerulosclerosis.) Up to 85% of cases are idiopathic.

The remainder occur secondary to the following:
*Systemic diseases - diabetes mellitus, solid tumors (lung and colon), and immunologic disorders (such as SLE)
*Certain drugs - gold penicillamine, and NSAIDs (drahmednawaz mentioned above)
*Infections - hepatitis B, hepatitis C, malaria, and syphilis

This patient's nephrotic syndrome and his underlying malignancy suggest membranous glomerulopathy. The microscopic findings presented are consistent with this diagnosis: uniform, diffuse thickening of the glomerular capillary wall on light microscopy. Electron microscopy reveals that this thickening is caused by irregular, dense deposits laid between the basement membrane and the epithelial cells. These protrusions resemble "spikes" when stained with silver. Immunofluorescence microscopy reveals that these granular deposits contain immunoglobulins (IgG) and C3.

click image to enlarge