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Lipoprotein Glomerulopathy With Complete Resolution With Fenofibrate: Report of First Case From Pakistan.
Shaker, Nada; Ben Musa, Ruwaida; Shaker, Nuha; Nasir, Humaira; Kamran, Tafiya Erum; Poombal, Fnu; Abid, Abdul; Abu Shakra, Rafat; Mansoor, Ibrahim.
Affiliation
  • Shaker N; Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, USA.
  • Ben Musa R; Biomedical Sciences, University of Missouri-Columbia, Columbia, USA.
  • Shaker N; Department of Pathology, University of Pittsburgh Medical Center Health System, Pittsburgh, USA.
  • Nasir H; Shifa International Hospitals Ltd, Islamabad, Pakistan.
  • Kamran TE; Shifa College of Medicine, Islamabad, Pakistan.
  • Poombal F; Department of Pathology, Nishtar Medical College and Hospital, Multan, Pakistan.
  • Abid A; Department of Pathology, University of Virginia School of Medicine, Charlottesville, USA.
  • Abu Shakra R; Department of Pathology, International Medical Center Hospital, Jeddah, Saudi Arabia.
  • Mansoor I; Pathology, Mayo Clinic, USA.
Int J Surg Pathol ; 32(7): 1404-1408, 2024 Oct.
Article in En | MEDLINE | ID: mdl-38327135
ABSTRACT

Background:

Lipoprotein glomerulopathy is an infrequent glomerular disorder that culminates in nephrotic syndrome and often progresses to kidney failure. Whereas most patients have been reported in Japan and China, limited reports have been documented outside these regions. This patient represents the first report of lipoprotein glomerulopathy in Pakistan. Case Presentation A 25-year-old male patient, hypertensive for 2 years, presented with progressive body edema, frothy urine, and fatigue. Examination revealed elevated blood pressure, bilateral pedal edema, and positive shifting dullness. Laboratory results showed significant proteinuria and elevated cholesterol and triglyceride levels. Renal biopsy revealed enlarged glomeruli with a dilated capillary lumen filled with pale-staining mesh-like material "lipoprotein thrombi." Mild tubular atrophy and interstitial inflammation were observed. No interstitial fibrosis was evident. Electron microscopy detailed the lipoprotein thrombi with lipid granules and vacuoles of various sizes. A diagnosis of lipoprotein glomerulopathy was rendered. Treatment with fenofibrate, rosuvastatin, and captopril led to notable improvements in symptoms, blood pressure, and lipid levels during a 6-month follow-up. Subsequent biopsy showed complete resolution of the lipoprotein thrombi and a significant reduction in subendothelial granular densities. However, the flocculent subendothelial material persisted to some extent despite the complete resolution of lipoprotein thrombi.

Conclusion:

This report underscores the rarity of lipoprotein glomerulopathy in Pakistan and contributes valuable insights into its histopathologic features and global epidemiology. This unique instance aims to raise awareness among healthcare professionals, aiding in improved recognition of this rare entity. The favorable response to fenofibrate treatment underscores its effectiveness in managing lipoprotein glomerulopathy.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Fenofibrate / Hypolipidemic Agents Limits: Adult / Humans / Male Country/Region as subject: Asia Language: En Journal: Int J Surg Pathol Journal subject: PATOLOGIA Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Fenofibrate / Hypolipidemic Agents Limits: Adult / Humans / Male Country/Region as subject: Asia Language: En Journal: Int J Surg Pathol Journal subject: PATOLOGIA Year: 2024 Document type: Article Affiliation country: Country of publication: