Histopathological pattern of glomerular lesions on percutaneous renal biopsy in proteinuric patients

Objective: To determine the histopathological pattern of glomerular lesions on per-cutaneous renal biopsy in patients presenting with proteinuria

Study Design: Cross-sectional descriptive study

Place and Duration of Study: Department of Medicine, Combined Military Hospital Peshawar, from Aug 2012 to May 2015

Material and Methods: From the adult patients undergoing renal biopsy for various indications in our department, we selected a cohort of 200 patients who had proteinuria of >/= 1 gram/24 hours on presentation. A percutaneous renal biopsy was performed in these patients and the specimens were subjected to histopathology and immunofluorescence studies. The results of biopsy findings were considered along with other clinical and laboratory data to reach conclusive clinico-histopathological diagnoses of various glomerular diseases

Results: Most patients with proteinuria [91%, n=182] have glomerular disease. Among glomerular diseases, primary ones are more common [69.8%] than secondary disorders [26.9%]. In our study cohort, focal segmental glomerulosclerosis is the most common diagnosis [23%], while lupus nephritisis the most common secondary glomerular disorder [7%]. Other common glomerular disorders are membranous nephropathy [12%], IgA nephropathy [9%], and post-infectious glomerulonephritis [6%]

Conclusion: Glomerular disease is common in patients presenting with proteinuria. Its histopathological pattern appears similar to that mentioned in many other studies of the region

Paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features of multiple myeloma

Black brown hyperpigmentation of the mucosae, sunexposed skin, palmar creases and frictional sites [Addisonian pigmentation] is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation.We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up

Clinical assistance of bone marrow examination in a secondary-care hospital

This study was performed to evaluate various clinical situations requiring bone marrow examination and to assess its advantages in a secondary care hospital. One hundred and five bone marrow examinations were performed from 1st April 2002 to 31st March 2003. The age ranged from 4 months to 70 years with a mean age of 32 years, 10 patients were children under the age of 15 years and 95 were adults. Male to female ratio was 3:1. Progressive pallor [26%], visceromegaly [25%], abdominal disturbances [19%], fever of unknown origin [8.5%], bleeding manifestations [8.5%], lymphadenopathy [8.5%] bone pains [5%], and suspected hematological malignancy [8.5%] were the common clinical situations where bone marrow examination was asked. Nutritional deficiency anemia constituted 61% of the bone marrow examination results. Other conditions were anemia of chronic disorder [13.5%], acute leukemia [5%], chronic leukemia [3%], multiple myeloma [2%], myelodysplastic syndrome[2%], congenital sideroblastic anemia[1%], storage disorder[1%] and metastatic bone disease[1%]. Bone marrow examination at secondary care hospitals carries many advantages. About 80% cases can be treated in these centers and do not require referral. The disease is usually at its early stage, marrow is unaffected by any therapy and has better diagnostic value