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Archived Comments for: Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis - an unusual association: a case report and review of the literature

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  1. Therapeutic approach in polycystic kidney disease associated to glomerulopathy is better defined after renal biopsy

    Gianna Mastroianni Kirsztajn, Federal University of Sao Paulo

    6 July 2010

    We agree with D’Cruz et al.1 in their paper “Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis – an unusual association” that renal biopsy should be performed in polycystic kidney disease when proteinuria is present. We believe it would be especially indicated if proteinuria is above 1 g/day, a level at which an immunosuppressive treatment could be initiated in case IgA nephropathy was diagnosed, for example 2.
    We disagree with the statement that the renal biopsy should be indicated to “exclude coexisting glomerular disease”, as nephrotic range proteinuria is always a manifestation of glomerular disease, and in their case it was present. The actual biopsy indication would be to define the histological type of such glomerulopathy, because in our days there are specific therapeutic approaches to each of them, and to most of them 3,4.
    Additionally in places where renal biopsy is routinely available, it is not acceptable that nephrotic syndrome in adult patients are empirically treated with immunosuppressive drugs neither with steroids; although the last approach is widely adopted and defensible in children, as there is an absolute predominance of minimal change disease in this age range 3. It is of note that empirical steroid therapy is not adequate even in adolescents, as it has been shown that glomerular diseases distribution in this group of patients resembles in fact that of adults and not of children 5.
    Finally different glomerulopathies have been diagnosed in patients with polycystic kidney disease1, and an accurate histological diagnosis of the former will definitely contribute to adequate management of both renal diseases.

    Gianna Mastroianni Kirsztajn, MD, PhD
    Glomerulopathy Section, Federal University of Sao Paulo (UNIFESP), Brazil

    E-mail: gianna@nefro.epm.br

    References
    1. D'Cruz S, Singh R, Mohan H, Kaur R, Minz RW, Kapoor V, Sachdev A. Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis - an unusual association: a case report and review of the literature. J Med Case Reports 2010, 29(4):125.
    2. Ballardie FW: Quantitative appraisal of treatment options for IgA nephropathy. J Am Soc Nephrol 18: 2806–2809, 2007.
    3. Bargmann JM: Management of minimal lesion glomerulonephritis: Evidence-based recommendations. Kidney Int 1999, 55(Suppl. 70): S26-32.
    4. Ponticelli C, Passerini P. Can prognostic factors assist therapeutic decisions in idiopathic membranous nephropathy? J Nephrol 2010, 23:156-163.
    5. Requião-Moura LR, Veras de S Freitas T, Franco MF, Pereira AB, Mastroianni-Kirsztajn G. Should adolescents with glomerulopathies be treated as children or adults? Nephron Clin Pract 2008, 109(3):c161-167.

    Competing interests

    None

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