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Nephrotic Syndrome Associated with Fanconi Syndrome: Immunopathogenic Studies of Tubulointerstitial Nephritis with Autologous Immune-Complex Glomerulonephritis

[+] Article, Author, and Disclosure Information

Grant support: by grants-in-aid from the Rocky Mountain Kidney Foundation; Colorado Heart Association; NIH general CFC grant RR-69; U.S. Public Health Service grants 5 SO1 RR 05357 and HD 04024.

This work was done during the tenure of an Established Investigatorship from the American Heart Association (Dr. McIntosh).

▸Requests for reprints should be addressed to Rawle M. McIntosh, M.D., Nephrology and Clinical Immunology, University of Colorado Medical Center, 4200 E. 9th Ave., Box C233, Denver, CO 80220.

Denver, Colorado

Ann Intern Med. 1976;84(4):433-437. doi:10.7326/0003-4819-84-4-433
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The nature of renal lesions in a patient with simultaneous onset of the Fanconi syndrome and nephrotic syndrome was investigated by immunologic studies of the patient's serum, cryoproteins, and renal tissue. Acute severe tubulointerstitial nephritis and generalized segmental glomerulonephritis were present. Renal tubular epithelial (RTE) antigen, IgG, and Clq were localized in the glomerull and proximal tubules. Cryoprecipitates containing RTE antigen and anti-RTE antigen were isolated from the patient's serum. Antibody to RTE antigen was detected in the serum of the patient. However, antibody to tubular basement membrane was not found in the cryoproteins or serum. The unusual simultaneous presentation of these two syndromes in our patient possibly represents a common etiology: tubular damage with release of RTE antigen and subsequent development of immune-complex glomerulonephritis mediated by renal tubular epithelial antigen and antibody to this antigen.





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