Simultaneous occurrence of perimembranous glomerulonephritis and glomerular amyloidosis

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Abstract
Summary The results of electron microscopic examination of renal biopsies from 3 patients with rheumatoid arthritis treated with penicillamine are presented. All 3 patients developed a nephrotic syndrome upon discontinuation of penicillamine therapy. When viewed with the electron microscope, segmental forms of perimembranous glomerulonephritis (Stages I–II of Ehrenreich and Churg) and glomerular renal amyloidosis Grade I–III were observed. In all three cases the nephrotic syndrome was considered to be due to the simultaneous occurrence of the two disease processes. In 2 cases perimembranous glomerulonephritis with immuno-complex-deposits was assumed to be the dominant factor in the causation of the disease, in the other case amyloidosis was the principle abnormality.