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Yamada, H. et al.

Harutaka Yamada, Naoto Miura, Wataru Kitagawa, Yukari Kashima, Seiko Matsui, Norio Ozeki, Kazuhiro Nishikawa, Hirokazu Imai,

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.[1]

References

Membranous nephropathy and pulmonary alveolar proteinosis. Yamada, H., Miura, N., Kitagawa, W., Kashima, Y., Matsui, S., Ozeki, N., Nishikawa, K., Imai, H. Intern. Med. (2007) [Pubmed]

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