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C3 and C4 levels were normal&#46; There was no monoclonal spike in serum proteinogram&#44; the virological study &#40;HbsAg&#44; HbcAb&#44; HbsAb&#44; hepatitis C antibodies&#44; and HIV antibodies&#41; was negative&#44; and tumour markers &#40;prostate specific antigen &#91;PSA&#93;&#44; carcinoembryonic antigen&#44; and alpha-fetoprotein&#41; were normal&#46;</p><p class="elsevierStylePara">Chest x-ray revealed pleuropulmonary parenchyma and hili without pathological signs&#44; except for very mild bilateral pleural effusion&#46; Renal biopsy was diagnostic of stage I MGN&#46; Immunofluorescence analysis showed subepithelial granular deposits strongly positive for IgG&#46;</p><p class="elsevierStylePara">The patient was started on conservative treatment with angiotensin-converting enzyme &#40;ACE&#41; inhibitors&#44; angiotensin receptor blockers &#40;ARB&#41; and a diuretic drug&#46; After three months&#44; the patient was admitted on two separate occasions due to anasarca and poor response to treatment&#44; and was started on immunosuppression with cyclosporine &#40;CsA&#41;&#46; By the fifth month post-biopsy&#44; he showed moderate effort dyspnoea and significant right pleural effusion&#46; We performed a thoracentesis with a positive cytological test for malignancy&#46; A thoraco-abdominal computed axial tomography revealed numerous positive lymph nodes&#46; Bronchoscopy was performed&#44; confirming stage IV lung adenocarcinoma with right pleural metastases&#46; Chemotherapy began with pemetrexed&#44; and the patient died after 2 months&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 2&#46;</span> Our second patient was a 59-year-old man&#44; smoker of 15 cigarettes per day&#44; with diabetes mellitus type 2&#46; He was admitted with oedema and had proteinuria at 14g&#47;day&#44; microhaematuria&#44; and preserved renal function&#46; Immunity and complement test results were normal&#46; Virus serology was negative&#46; PSA test was normal&#46; Lung and gastrointestinal tumour markers were negative&#46; Chest x-ray revealed normal pleuropulmonary parenchyma&#46; An ultrasound demonstrated normal kidneys&#46; A renal biopsy was diagnostic of stage I MGN</p><p class="elsevierStylePara">Conservative treatment began with ACE inhibitors and ARBs&#46; At the fourth month of diagnosis&#44; due to lack of response&#44; CsA was started without success&#46; After sixth month&#44; the patient was switched to treatment with chlorambucil and prednisone for eight months with no response&#44; and this treatment was suspended due to leukocytopenia&#46; A year and a half after the biopsy&#44; partial remission was reached &#40;proteinuria&#58; 5g&#47;day&#41; with conservative treatment&#46; After two years&#44; a node appeared in the left lower lung lobe &#40;Figure&#41;&#46; Fibre-optic bronchoscopy confirmed stage IV squamous cell carcinoma&#46; Further analyses showed numerous nodules indicative of pleural&#44; bone and liver metastases&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the aetiological analysis of the MGN&#44; in which cases must we be &#39;aggressive&#39; in screening for malignancy&#44; and to what extent&#63; In case 1&#44; the appearance of MGN and a solid tumour was simultaneous&#44; without clear clinical evidence of cancer&#46; In case 2&#44; the tumour appeared 2 years after the diagnosis of MGN&#44; coinciding with partial remission&#44; which calls into question a causal relationship&#44; because it is more plausible that this was a case of a latent tumour activation caused by immunosuppression&#46;</p><p class="elsevierStylePara">Approximately 10&#37; of the MGN are paraneoplastic&#44; secondary to lung&#44; prostate and gastrointestinal tumours&#46;<span class="elsevierStyleSup">1 </span>Lung cancer is the most common tumour type in adult males&#44;<span class="elsevierStyleSup">2</span> smokers&#44; and patients older than 65 years&#46; Many authors advocate an aggressive screening protocol in patients with MGN&#46; The relationship between cancer and MGN may be causal or the consequence of immunosuppressant therapy&#44; or it could be just coincidence&#46; The appearance of tumours has been described as many as 5 years after the diagnosis of MGN&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In recent years&#44; the controversy between idiopathic and secondary causes seems to be somewhat clearer&#46; M-Type phospholipase A2 receptor is associated with idiopathic MGN&#44;<span class="elsevierStyleSup">4</span> and the same can be said of anti-aldose reductase and anti-manganese superoxide dismutase&#44; while the absence of IgG4 glomerular deposits suggests a neoplastic process&#46;<span class="elsevierStyleSup">5</span> However&#44; these diagnostic techniques are still unavailable in many hospitals&#46;</p><p class="elsevierStylePara">Our cases showed two distinct patterns of association between MGN and tumours&#46; We believe that attending physicians must pay close attention to these patients from the moment of diagnosis and throughout the patient follow-up period in order to facilitate the early detection of cancers that might affect patient prognosis&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11542&#95;16025&#95;33388&#95;en&#95;f1&#95;11542&#95;copy1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11542_16025_33388_en_f1_11542_copy1.jpg" alt="Lateral chest x-ray"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Lateral chest x-ray</p>"
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