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[Nephrotic syndrome with microcellular projections into the thickened basement membrane]
T Kimura1, Y Suzuki, K Igarashi
1Department of Nephrology, National Medical Center Hospital, Tokyo, Japan.
Abstract:
A 47 year-old patient with an 8-year history of proteinuria was admitted to our hospital in 1989. His laboratory data were compatible with nephrotic syndrome: total serum protein 5.9g/dl (albumin 3.0g/dl), total serum cholesterol 280mg/dl and total urinary protein excretion 5.0g/day. Renal biopsy specimens contained 27 glomeruli associated with sclerosis and collapse of loops under light microscopical examination. In addition, mesangial proliferation and thickening of the basement membrane were visualized. With immunofluorescent study granular IgG deposits were detected in the peripheral region of the glomeruli. Staining for IgA, IgM, C3, Clq, light chain and Congo-red were all negative. On electron microscopy, microtubules apparently resembling cellular projections appeared to thicken the basement membrane. We are tempted to conclude that the current case is an atypical glomerulopathy accompanied by a glomerular microtubular-like structure.
Insights
This study reports a rare case of nephrotic syndrome in a 47-year-old patient, revealing an atypical glomerulopathy with unique microtubular-like structures in the glomeruli. Further research is needed to understand this rare kidney disease.
Area of Science:
- Nephrology
- Pathology
- Electron Microscopy
Background:
- A 47-year-old male patient presented with an 8-year history of proteinuria.
- Laboratory findings indicated nephrotic syndrome, characterized by hypoalbuminemia, hypercholesterolemia, and significant proteinuria.
Observation:
- Renal biopsy revealed glomerular sclerosis, loop collapse, mesangial proliferation, and thickened glomerular basement membranes.
- Immunofluorescence showed granular IgG deposits in peripheral glomeruli, with negative staining for IgA, IgM, C3, C1q, light chains, and Congo-red.
- Electron microscopy identified microtubule-like structures within the glomerular basement membrane.
Findings:
- The patient's condition was diagnosed as an atypical glomerulopathy.
- The presence of glomerular microtubular-like structures is a distinctive feature of this case.
Implications:
- This case highlights a rare presentation of glomerulopathy with unique ultrastructural findings.
- Further investigation into the nature and origin of these microtubular structures is warranted.
- Understanding this atypical glomerulopathy may offer new insights into kidney disease pathogenesis.