The bronze kidney: membranous glomerulonephritis associated with iron overload

A 55-year-old man with a history of diabetes mellitus, hypertension and hypercholesterolaemia developed increasing peripheral oedema over the course of several months. He was found to have nephrotic range proteinuria (15.7 g/24 h). His renal ultrasound scan was normal and the autoimmune screen was negative. His renal biopsy demonstrated evidence of membranous glomerulonephritis and increased iron deposition. At this juncture, a serum ferritin was checked which showed an initial value 933 µg/L with transferrin saturation at 96.6%. A subsequent liver biopsy also showed evidence of iron overload but without fibrotic changes. Genetic studies including C282Y HFE, ferroportin and DMT1 studies were also negative. He was subsequently treated with interval venesection which was associated with significant symptomatic and biochemical evidence of improvement in oedema and proteinuria.