PMC3966568_01
Membranous nephropathy. a Light microscopy of a glomerulus showed mild thickening of peripheral capillary walls without conspicuous spikes and intraglomerular proliferation (periodic acid-Schiff stain). b Immunofluorescence microscopy revealed coarsely granular immunoglobulin (Ig)G staining mainly along the capillary walls (IgG fluorescein isothiocyanate). c Electron microscopy image identified diffuse subepithelial electron dense deposits with early or no spikes and foot process effacement
nihms562262f1.jpg
PMC3966568_01_nihms562262f1.jpg
F1
At 9 months after enrollment, her initial kidney biopsy was verified as being idiopathic MN and not IgA nephropathy due to an error in reporting the IgA fluorescein isothiocyanate (see Fig. 1a-c).
Treatment course and laboratory results in the patient before and after initiation of bortezomib. A timed 24-h urine collection showed protein excretion of 6.5 g before kidney biopsy and 7.4 g at study screening. However, both collections were incomplete regarding the total creatinine amount, which was also measured. Repeat 24-h timed urine collections after the initiation of bortezomib treatment showed protein excretion of 13.9 g at 2 weeks, 2.4 g at 6 months, 0.55 g at 9 months and 0.36 g at 12 months
nihms562262f2.jpg
PMC3966568_01_nihms562262f2.jpg
F2
Her nephrotic syndrome was resistant to 6 months of high-dose oral prednisone and ramipril (10 mg/day) (Fig. 2). The serum albumin was 1.3 g/dl 1 week prior to the kidney biopsy and remained below 1.9 g/dl from 1 month after the biopsy until screening (Fig. 2). Serum creatinine was 1.2 mg/dl 1 week prior to the kidney biopsy and remained below 0.8 mg/dl from 1 month after biopsy until it started rising to 0.97 mg/dl at screening (Fig. 2). Ramipril (10 mg/day) and prednisone (10 mg/day) were continued after enrollment (Fig. 2). Concurrent with an increase in serum albumin to 2.9 g/dl, the UP:C ratio decreased to 4.19 mg/mg after bortezomib infusion (Fig. 2). We had observed that the serum creatinine was rising at screening and it peaked at 1.56 mg/dl before it improved 4 months after bortezomib treatment (Fig. 2).