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NDT Plus Advance Access originally published online on November 12, 2008
NDT Plus 2009 2(1):63-66; doi:10.1093/ndtplus/sfn167
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

When the finding of glomerular fibrils in patients with nephrotic syndrome leads to an erroneous diagnosis

Ana Huerta, Beatriz Segovia, Aurelio Hernández, Enrique Morales, Jorge González, Eva Mérida, Miguel Angel Martínez and Manuel Praga

Departments of Nephrology and Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain

Correspondence: Correspondence and offprint requests to: Manuel Praga, Servicio de Nefrología, Hospital 12 de Octubre, Avda de Córdoba s/n, 28041 Madrid, Spain. Tel: +(34)913908383; Fax: +34-91-4692422; E-mail: mpragat@senefro.org

Key Words: fibrillary glomerulonephritis • minimal change disease • nephrotic syndrome • nonspecific glomerular fibrils

Received for publication September 8, 2008. Accepted for publication October 8, 2008.

The first 150 words of the full text of this article appear below.


   Background
 
The finding of fibrils in the examination of renal biopsies by electron microscopy represents a very important clue for establishing a precise diagnosis [1–5]. This assertion is particularly important in patients with nephrotic syndrome (NS) or severe proteinuria, because most renal diseases characterized by the glomerular deposition of fibrils have proteinuria, generally in the nephrotic range, as the commonest clinical presentation. In this context, nephrologists and pathologists tend to automatically establish a causative link between the finding of fibrils in a particular patient with proteinuria and the aetiology of his/her renal disease. Nevertheless, some isolated studies have suggested that glomerular fibril deposition may be a nonspecific finding of unknown significance in some cases. Here we report on two cases that illustrate well how the finding of fibrils on electron microscopy can induce an erroneous diagnosis that only the final outcome of the patients (spontaneous resolution of the NS) . . . [Full Text of this Article]


   Case reports
 
Case 1
Case 2

   Discussion
 

   Teaching points
 

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