Membranous nephropathy and pulmonary alveolar proteinosis.
A 47-year-old woman with a severe cough and high-grade fever demonstrated proteinuria of 3.2 g/day. Chest radiograph and CT scan revealed scattered small nodules and ground-glass opacities with interlobular septal thickening in both lungs. The serum levels of surfactant A, surfactant D, and KL-6 were increased to 190 ng/ml (normal: 0-43.8), 360 ng/ml (normal: 0-110), and 4850 U/ml (normal: 0-500), respectively. Video-assisted thoracoscopic lung biopsy revealed eosinophilic amorphous material within alveoli and thickened alveolar septa, which is compatible with pulmonary alveolar proteinosis. Kidney biopsy exhibited membranous nephropathy (Stage I-II) accompanied by granular IgG deposition along the glomerular basement membrane. Although the patient refused treatment with granulocyte macrophage colony stimulating factor (GM-CSF) for pulmonary alveolar proteinosis, her proteinuria and the pulmonary lesion gradually diminished and disappeared after one year.
Yamada
Harutaka
H
Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine. harutaka@aichi-med-u.ac.jp
Miura
Naoto
N
Kitagawa
Wataru
W
Kashima
Yukari
Y
Matsui
Seiko
S
Ozeki
Norio
N
Nishikawa
Kazuhiro
K
Imai
Hirokazu
H
D001323:Autoantibodies; D014408:Biomarkers, Tumor / Q000276:immunology; D004268:DNA-Binding Proteins / Q000276:immunology; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000276:immunology; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D012075:Remission, Spontaneous; D025521:Tumor Suppressor Proteins / Q000276:immunology