title: Idiopathic Membranous Nephropathy: Diagnostic and Therapeutic Challenges.
abstract: BACKGROUND
  In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. While a majority of cases of MN are idiopathic, secondary forms can be seen in the setting of autoimmune disease, neoplasia, infection, and after being exposed to certain therapeutic agents. Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections could cause MN. However, the effect of coexisting HIV and HCV infection on the spectrum and progression of kidney disease as well as the effect of MN treatment on HIV and HCV infection are not well known.
  
  
  METHODS
  In this study, we describe a patient with hemophilia A and acquired HIV and HCV infections, a patient who developed severe nephrotic syndrome and for whom renal biopsy showed MN.
  
  
  RESULTS
  Patient responded well to adrenocorticotropic hormone gel without adversely affecting HIV or HCV infections.
  
  
  CONCLUSIONS
  Adrenocorticotropic hormone gel might be useful in the management of complex cases of idiopathic MN.
authors.affiliation: Division of Nephrology, University of Kentucky, Lexington, Ky., USA.
authors.forename: Amr
authors.initials: A
authors.lastname: El-Husseini
authors.forename: David
authors.initials: D
authors.lastname: Saxon
authors.forename: Stuart
authors.initials: S
authors.lastname: Jennings
authors.forename: Virgilius
authors.initials: V
authors.lastname: Cornea
authors.forename: Laurence
authors.initials: L
authors.lastname: Beck
authors.forename: B Peter
authors.initials: BP
authors.lastname: Sawaya
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000906:Antibodies / Q000032:analysis*; D060085:Coinfection / Q000150:complications; D005782:Gels; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006526:Hepatitis C / Q000150:complications; D006728:Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D054507:Receptors, Phospholipase A2 / Q000276:immunology; D019699:Thrombospondins / Q000276:immunology
chemical_list: D000906:Antibodies; D005782:Gels; D006728:Hormones; D054507:Receptors, Phospholipase A2; C546399:THSD7A protein, human; D019699:Thrombospondins; D000324:Adrenocorticotropic Hormone