[Membranous glomerulonephritis. Experience at the Instituto Nacional de la Nutrición Salvador Zubirán]. / Glomerulonefritis membranosa. Experiencia en el Instituto Nacional de la Nutrición Salvador Zubirán.

The purpose of this retrospective study was to study the incidence of idiopathic and secondary forms of membranous nephropathy in our institution, its clinical course and progression to chronic renal failure, and the risk factors associated with it. Two hundred fourteen (16%) of the 1,287 renal biopsies obtained between 1962 and 1988 were primary glomerular diseases and 28 of this 214 (13%) were idiopathic membranous nephropathy. On the other hand 59 of 1,287 biopsies were membranous nephropathy of whom 28 were idiopathic, 27 secondary to systemic lupus erythematosus, 2 due to drugs, one associated with rheumatoid arthritis, and one more with breast cancer. The clinical picture was: nephrotic syndrome in 84%, hypertension in 15%, non-nephrotic proteinuria in 14%, chronic renal failure in 8.4%, and renal vein thrombosis in 6.3%. In the idiopathic group 75% of the patients were male while in the lupus group 85% were female. For the analysis of progression to chronic renal failure we excluded 5 patients with renal failure when the biopsy was taken, 2 because the nephropathy was due to drugs, one associated with breast cancer, and nine were within the first year of follow-up. Thus, for this analysis the group consisted of 22 patients with idiopathic form and 20 with systemic lupus erythematosus. The idiopathic and lupus groups were similar except for a lower serum albumin in the former. The progression to renal failure was seen in 9 patients: six in the idiopathic group and the other 3 in the lupus group; this difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic laparotomy in fever of unknown origin.

Twenty five consecutive patients with fever of unknown origin (FUO) who underwent diagnostic laparatomy (DL) are reviewed. There were 14 females and 11 males, with a mean age of 34 years. The main symptoms and signs besides fever were malaise, weight loss, varied abdominal complaints, peripheral lymph nodes enlargement, hepatomegaly and splenomegaly. The main laboratory abnormalities were: anemia, leukocytosis, and mild alterations in liver function tests. CT scan was performed in 14 patients: hepatomegaly, splenomegaly and or retroperitoneal nodes were found in 10 of them. During laparotomy, an extensive exploration of intra-abdominal organs was performed, taking multiple biopsies for histopathologic and microbiologic analysis. Splenectomy was performed in 17 patients, prophylactic appendectomy in four, and cholecistectomy in one. Laparotomy was useful to establish a diagnosis in 64 percent of cases. The most frequently diagnosed pathologies were lymphoma and tuberculosis. Postoperative morbidity was 12% and mortality was 4%. Mean follow-up was 29 months. When preoperative data were analyzed, no predictive factors were found for a laparotomy with diagnostic success. It is concluded that DL is a useful last-step procedure in the diagnostic work-up for patients with FUO.