Alport-like glomerular changes in a patient with nephrotic syndrome: report of a case

We report a 17-year-old Saudi girl who presented with nephrotic syndrome at the age of 7 years. A renal biopsy revealed a mildly proliferative immune complex-mediated glomerulonephritis, which on ultrastructural examination r evealed prominent thickening of the capillary basement membranes, along wit h marked splitting and lamellation of lamina densa resembling those seen in Alport syndrome. These changes were even more pronounced in renal biopsies performed 1 and 3 years later, respectively. Thorough clinical evaluations and follow-up of more than 10 years failed to reveal any evidence of Alpor t syndrome. Review of the literature revealed four similar cases reported p reviously. Diffuse and prominent Alport-like glomerular changes may rarely be seen in patients with nephrotic syndrome in the absence of Alport syndro me. Pathogenesis of these changes, however, remains to be understood.