Conclusions:
This case highlights the importance of always investigating in patient’s nephrotic syndrome, a paraneoplastic cause, especially when there are associated risk factors. We observed how difficult it is to identify publications that evidence the association between focal segmental glomerulosclerosis (FSGS) and cancer, especially melanoma. And with that, it is still necessary to develop serum biomarkers and histological evidence that the associations between the development of FSGS in cancer patients. Regarding the controversial role of immunosuppression in these cases, especially if the disease is relapsed or if the patient needs chemotherapy, it still needs to be individualized on a case by case. In this patient there was a clear benefit in immunosuppression, especially in preserving renal function and promoting control of nephrotic syndrome adjuvant to tumor treatment.
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Figures:
Figure 1: Glomerulus with segmental and focal sclerosis in patient with melanoma, stained by Schiff’s periodic acid method. (400x magnification)
Figure 2: Glomerulus with segmental and focal sclerosis in patient with melanoma, stained by the Schiff’s periodic acid method. (400x magnification)
Figure 3: Glomerulus with segmental and focal sclerosis in patient with melanoma, stained by the periodic acid-silver methenamine (PAMS) method. 400x magnification