Acute tubulointerstitial nephritis and polyclonal hypergammaglobulinaemia: Which is the culprit?

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient's evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease.

Síndrome nefrótico, anticuerpos anti-PLA2R y glomerulonefritis membranosa. ¿Es necesaria la biopsia renal? / Nephrotic syndrome, anti-PLA2R and membranous glomerulonephritis. Is the renal biopsy necessary?

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Adenocarcinoma y tumor carcinoide pulmonares sincrónicos. Presentación de dos casos / Two cases of synchronous adenocarcinoma and carcinoid tumour of the lung

La asociación de tumor carcinoide y carcinoma broncopulmonar en forma de tumores de aparición sincrónica es excepcional y sólo ha sido publicada en diez ocasiones. En el presente trabajo se describen los hallazgos en 2 pacientes con adenocarcinoma pulmonar en los que en el estudio de la pieza quirúrgica se identificó un tumor carcinoide típico. El hallazgo de un segundo nódulo en un paciente con un carcinoma broncopulmonar, situación cada vez más frecuente por la incorporación de técnicas de imagen con mayor sensibilidad, plantea la necesidad de su evaluación patológica para una correcta estadificación. Un problema adicional es la identificación de segundos nódulos en el curso de la intervención quirúrgica, lo que obliga al estudio intraoperatorio. La correcta valoración de los parámetros morfológicos y su comparación con los del tumor principal puede ser determinante en un correcto diagnóstico y evitar la sobrestadificación(AU)

The association of carcinoid tumour and bronchopulmonary carcinoma is very rare, with only 10 cases published to date. We present two cases of pulmonary adenocarcinoma in which a typical carcinoid tumour was an incidental finding on microscopy of the surgical specimen. The improved sensitivity of imaging techniques increases the possibility of detecting the presence of secondary nodules during the work-up for bronchopulmonary carcinoma, indicating further intraoperatory investigation. A correct morphological assessment and comparison with the main tumour could prove to be a key diagnostic factor, avoiding incorrect overstaging(AU)