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66 YO M comes to office with back pain on/off for 1 year,recently he has had fatigue,generalized edema .He also c/o urgency,hesitancy,weak stream,U/A show proteinuria 4+ with no hematuria,vitals sign WNL.
Which of the following glomerular diseases is most likely to be present in this pt?
a.amyloidosis
b.FSGS
c.minimal change disease
d.MPGN
e.membranous nephropathy
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back pain plus no hematuria and symptoms of urinary urgency,hesitancy,weak so i am thinking deposition of amyloid can cause these obstructive like symptoms.
age 66 so cant be minimal change disease
or may be membranous nephropathy due to DM...?
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Well, i have not given much hints about the cancer...
But just wanted to show association of prostrate cancer with membranous nephropathy!!
Just wanted to stress the fact about membranous nephropathy being the most common form of nephrotic syndrome a/w usu. solid cancers (lung,colon,prostrate,breast)
But,if Hodgkin's lymphoma be given in the qsn,it will be minimal change disease!!
Sorry if the information was not adequate,
Will come up with more hints and twists next time..
Thank u for the discussion (:
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thanks point taken....
will wait for more discussion ...good way to learn
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Just to add, another good differential will be multiple myeloma with AL amyloid deposite in kidneys causing nephrotic syndrome. Back pain from osteolytic effect on d spine.
Thanks for d question
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Thank u for the d/d.
I realize that the information i have provided is incomplete
But just wanted to come up with the take home message, as mentioned above!!
Thank you (:
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I think multiple myeloma is a good one to consider for an elderly with back pain and renal disease. In this case amyloidosis which also can present with proteinuria, is a good choice with 30% incidence in MM. However, his obstructive sysmptoms seem to be more like prostate cancer to which a renal disease has been added. Membranous most common GN associated with malignancies so this could be a very good choice even though MPGN is also seen with prostate cancer. So as happy mentioned before I think I can put membranous higher in my list.
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Yeah, u are right!! MM is indeed one of the d/d...
My purpose was to highlight the association of solid organ cancer with membranous nephropathy!!
I should have provided more info to r/o amyloidosis which i havent!!
Will work on that ...
Thank you!!
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