A case of acquired renal cystic disease (ACDK) with oncocytosis, a dominant nodule (oncocytoma) multiple adenomas and a microscopic papillary renal cell carcinoma associated with crescentic glomerulonephritis
Sir, A 76 year old female patient suffering from long term arterial hypertension had a nephrotic syndrome in 1997, being diagnosed of membranous glomerulonephritis clinically and with biopsy. She was resistant to steroids and azathioprine. Then, her treatment was changed to Mycophenolate Mofetil. In 2005, she had anuria, abdominal discomfort and acral edema. Serologic studies were negative. Hemodyalisis, besides steroids and cyclofosphamide treatment were started. Her renal function was worsening and a new biopsy showed a crescentic glomerulonephritis with epithelial crescents, severe tubulointerstitial changes and focal tubular hyperplasia. IF studies were identical to the previous biopsy and consistent with membranous glomerulonephritis (granular peripheral glomerular deposits of Ig G, C3 and C1q) EM is not available. CT scan and MRI displayed multiple renal cysts suggesting ACDK with a 2.5 cm solid nodule and a total right nephrectomy was performed. The removed kidney (Fig. 1) had multiple cysts, numerous minute nodules and a tangreen 2.5 cm mass. Studied by routine methods and immunohistochemistry (cytogenetics and EM are not available) a crescentic GN with many obsolescent glomeruli was found (Fig. 2) There were prominent tubulointerstitial changes: severe tubular atrophy, frequent tubular hyperplasia and oncocytic changes, sometimes papillary; Virchows Arch (2007) 450:365 367 DOI 10.1007/s00428 006 0324 0
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