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Virtual case of the month
Nephrotic syndrome in a 60-year-old man
  1. Miguel Garcia Pardo1,
  2. Inmaculada Aparicio1,
  3. Marta Arregui1,
  4. Rosa Melero2,
  5. Francisco Díaz3,
  6. Rosa Álvarez1,
  7. Antonio Calles1,
  8. Miguel Martin1
  1. 1 Medical Oncology, Hospital General Universitario Gregorio Maranon, Madrid, Spain
  2. 2 Nephrology, Hospital General Universitario Gregorio Maranon, Madrid, Spain
  3. 3 Pathology, Hospital General Universitario Gregorio Maranon, Madrid, Spain
  1. Correspondence to Dr Miguel Garcia Pardo, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain; miguelgarcia.pds{at}gmail.com

https://doi.org/10.1136/jclinpath-2019-206298

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    Clinical question

    A man in his 60s presented with increased oedema in the lower limbs and dyspnoea. Chest X-ray showed right pleural effusion and a body CT scan revealed a severe right pleural effusion as well as presence of solid nodules and pleural plaques. It was decided then to obtain a CT-guided pleural biopsy. Pathology of this biopsy showed an epithelioid mesothelioma. Blood test showed hypoproteinaemia (4.2 g/dL) with hypoalbuminaemia (2.2 g/dL), proteinuria of 1.4 g /24 hours and non-oliguric acute renal failure with serum creatinine of 3.28 mg/dL. A renal biopsy was performed (online supplementary appendix 1).

    Supplemental material

    [jclinpath-2019-206298supp001.pdf]

    Review the high quality, interactive digital Aperio slides at http://virtualacp.com/JCPCases/jclinpath-2019-206298/001/, http://virtualacp.com/JCPCases/jclinpath-2019-206298/002/, and http://virtualacp.com/JCPCases/jclinpath-2019-206298/003/, and consider your diagnosis.

    What is your diagnosis?

    1. A (secondary) amyloidosis

    2. Collapsing variant of focal segmental glomerulosclerosis

    3. Diabetic nephropathy

    4. Membranous nephropathy

    5. Minimal change disease.

    The correct answer is after the Discussion.

    Discussion

    A clinical suspicion of secondary membranous nephropathy (MN) was made due to the increase …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Correction notice This article has been corrected since it was published Online First. Aperio slide links have been corrected.

    • Contributors All authors contributed significantly to this manuscript. MGP, IA and MA contributed equally to this work, collecting data, searching references and writing the first draft. RM helped at the diagnosis and treatment of the nephropathy and help us with the additional studies requested. FD advised on renal and pleural histology. RA, AC and MM contributed to this work revising it critically for important intellectual content. All authors have read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.