Figure 520

Membranous glomerulonephritis and the nephrotic syndrome in a patient with bronchogenic carcinoma. A 76-year-old veteran presented with ankle edema and weight gain of 8 weeks' duration. He was noted to have the nephrotic syndrome with 5 grams of protein-uria per day. A chest radiograph revealed a perihilar mass. A bron-choscopic biopsy of the mass was diagnostic of malignancy. He was managed conservatively with diuretics and radiotherapy for the chest mass. He died 10 months later. Membranous glomeru-lonephritis and bronchogenic carcinoma were diagnosed at autopsy.

A, Light microscopic study of the kidney of this patient. Note the thickening of capillary walls and spikes (PAM stain). B, Immuno-fluorescence microscopy of renal tissue showing peripheral glomerular capillary deposition of IgG in a granular pattern indicative of immune-complex-mediated glomerulonephritis.

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FIGURE 5-20 (Continued)

C, Electron microscopy of the glomerulus showing subepithelial electron-dense deposits along the capillary walls. There is effacement of the epithelial cell foot processes, which is a common finding in patients with nephrotic syndrome. D, Bronchogenic carcinoma noted at autopsy in this patient (hematoxylin and eosin stain).

Membranous glomerulonephritis is an immune-complex-mediated glomerular disease, often resulting in nephrotic syndrome as a clinical manifestation. In adults older than the age of 50, a coexisting malignancy, usually a carcinoma, may be present in up to 10%

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