Letter to the Editor NEPHRON Nephron 1996;73:340-341 G. Salvidio F. Fiorini G. Garibotto Dipartimento di Medicina Interna. Division of Nephrology. Genoa. Italy Long-Term Response of Renal Function in Crescentic Membranous Glomerulonephritis after Plasma Exchange and Immunosuppressive Therapy Dear Sir, The association of crescentic glomerulo nephritis and membranous nephropathy is a rare condition. The natural history of the disease is characterized by nephrotic syn drome and rapidly progressive glomerulone phritis (RPGN) leading to end-stage renal failure (ESRF) [1], Wc report a case of a young patient with crescentic membranous glomerulonephritis who normalized renal function after immu nosuppressive treatment. A 24-year-old man was admitted to our division for nephrotic syndrome with renal failure. One year earlier, he presented pro teinuria. microhematuria and normal renal function. Six months prior to admission, he showed peripheral edema and hypertension and was treated with furosemide 25 mg/day and prednisone 25 mg/day. On admission, physical examination revealed generalized edema and severe hypertension (190/120). Laboratory data showed: hemoglobin 11.1g/ dl. hematocrit 32.3%, WBC 5,600/mm3. platelet count 337.000/mm\ ESR 66 mm at the lsth. BUN 32 mg/dl, serum creatinine 2.5 mg/dl. Urinalysis showed 8 RBC per high-power field (HPF) and fatty casts 3-6/ HPF. 24-hour protein excretion was 30 g and throat culture was negative. Serum albu min was 1.6 g/1, serum C3 was normal. ANA. anti-DNA antibodies, cryoglobulins and cir culating anti-GBM antibodies were absent. Echotomography showed enlarged kidneys, ECG and chest X-ray were normal. Five days after admission, serum creatinine rose from 2.5 to 4.3 mg/dl. A percutaneous renal biopsy was per formed: eleven glomeruli showing dilTuse basement membrane thickening were pres- Fig. 1. Diffuse spiking of the epithelial side of glomerular base ment membrane. On the left side of the picture a cellular crescent is present. Siiver-Methanammc. x 500. Fig. 2. Glomerulus with a circumferential cellular crescent. Thickening of capillary walls and mesangial sclerosis are also present. PAS. x 250. KARGER E-Mail kargcr(akarger.ch Fax ♦ 4I 6I 306 12 34 •V 1996 S. Karger AG, Base! 0028—2766/96/0732—0340S I0.00/0 Gennaro Salvidio. MD Dipartimento di Medicina Interna Division o f Nephrology Vialc Benedetto XV, 6 I—16132 Genova (Italy)