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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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