Membranous Glomerulonephropathy Associated with Psoriasis vulgaris

Takanobu Sakemi, MD, Department of Internal Medicine, Saga Medical School, Nabeshima, Saga 849 (Japan) Dear Sir, Many pathological conditions are linked to membranous glomerulonephropathy (MGN). Torres and Donadio [1] described dermatological diseases such as bullous pem-phigoid and dermatitis herpetiformis associated with MGN, but there are few detailed descriptions. We have reported on a rare case of MGN associated with psoriasis vulgaris (PV). To our knowledge, this is the second case of MGN in a patient with PV [2]. This case might throw light on the relation between MGN and PV. A 50-year-old man was admitted to a nearby hospital because of systemic edema and itching on his back in April 1988. Physical examination on admission revealed no obvious eruption on his back. Laboratory data were as follows: proteinuria 2 g/day and serum total protein (TP) 5.6 g/dl. A diagnosis of MGN was made by renal biopsy and he was treated with diuretics and antiplatelet drugs as an outpatient. Six months later, he developed an eruption on his back with itching as well as persistent edema and received an initial daily dose of 20 mg of prednisolone (PSL) with gradual tapering because of a good effect on skin lesions. Ten months later, however, in October 1990 when 7.5 mg of PSL were given daily, the nephrotic syndrome (NS) worsened with resulting deterioration of the renal function from 0.91 mg/dl in serum creatinine levels to 1.73 mg/dl, accompanied by the development of red colored papulae with marked scale which had spread over his whole skin. The diagnosis of PV was made by a dermatologist at the other hospital. He was transferred to our hospital for the treatment of PV (fig. 1) and NS on March 22, 1991. Laboratory data on admission were as follows: proteinuria 4 g/day, TP 4.9 g/dl, albumin 2.5 g/dl, creatinine 2.18 mg/dl, total cholesterol 415 mg/dl, IgG 990 mg/dl, IgA 239 mg/dl and IgM 153 mg/ dl. The rheumatoid factor, antinuclear antibody and anti-DNA antibody were all negative. No hypocomplementemia was observed. Circulating immune complexes were not measured. Renal biopsy showed thickening of glo-merular capillary walls. An immunofluores-cence study showed deposits of IgG, IgA and C3 along the glomerular capillary walls (fig. 2). Electron microscopy showed stage III which is characterized by numerous in-tramembranous or subepithelial deposits encircled by newly formed glomerular basement membrane-like materials (fig. 3).