Imaging Gross Pathology
A 47 -year-old black diabetic female complains of weight loss, progressive shortness of breath, and swelling of the lower legs and arms.
Her past medical history is unremarkable.
Pallor; pitting edema in extremities; decreased lung sounds with crackles bilaterally in lower lung fields; periorbital edema; ascites.
UA: proteinuria (> 3.5 g/24 hr); lipiduria with oval fat bodies and fatty and waxy casts in urinary sediment. Hypoalbuminemia (< 3 g/dL); hyperlipidemia (serum cholesterol 250 mg/dL).
Kidneys enlarged, pale, and rubbery; renal vein thrombosis may be present.
Thickened basement membrane; deposits of IgG and C3
along basement membrane seen in "spike and dome" pattern on methenamine silver stain; immune deposits in a "lumpy-bumpy" (discontinuous) pattern on immunofluorescence.
Corticosteroids; cyclophosphamide; renal transplantation; acetylcholinesterase inhibitors reduce urinary protein loss.
May be idiopathic or caused by membranous glomerulonephritis (most common cause in adults), minimal change disease (= LIPOID NEPHROSIS) (most common in children), focal glomerulosclerosis, or membranoproliferativc glomerulonephritis. Patients with nephrotic syndrome have hypercoagulability secondary to loss of antithrombin III in the urine (e.g., increased incidence of peripheral vein thrombosis). p-250
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