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Skinner SM, Specht AJ, Cicchirillo V, Fox‐Alvarez S, Harris AN. Association of proteinuria at time of diagnosis with survival times in dogs with lymphoma. J Vet Intern Med 2024; 38:2633-2641. [PMID: 39001675 PMCID: PMC11423466 DOI: 10.1111/jvim.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Lymphoma has been implicated as a possible cause of proteinuria in dogs. However, information about the potential importance of proteinuria in dogs with lymphoma is limited. HYPOTHESIS To determine if the presence of proteinuria at diagnosis was associated with median survival times in dogs with lymphoma and if lymphoma stage (I-V) or type (B vs T) were associated with the presence of proteinuria. ANIMALS Eighty-six client-owned dogs with a new diagnosis of lymphoma between 2008 and 2020. METHODS This was a retrospective cross-sectional study with dogs divided into proteinuric or nonproteinuric groups based on dipstick urine protein (protein ≥30 mg/dL classified as proteinuric) or a ratio of dipstick protein to urine specific gravity (ratio ≥1.5 classified as proteinuric). Dogs were excluded for: (1) treatment within 2 months with glucocorticoid, anti-neoplastic, or anti-proteinuric therapies, (2) diagnosed hypercortisolism or renal lymphoma, (3) active urine sediment, or (4) urine pH >8. Survival analysis utilized a Kaplan-Meier estimator and log-rank testing. RESULTS There was a significant difference in median survival between proteinuric and nonproteinuric dogs classified by urine dipstick (245 days [91, 399] vs 335 days [214, 456]; P = .03) or UP : USG (237 days [158, 306] vs 304 days [173, 434]; P = .03). No difference in prevalence of proteinuria was identified between stages (I-V) or types (B and T). CONCLUSIONS AND CLINICAL IMPORTANCE Proteinuria appears to be negatively associated with survival time in dogs newly diagnosed with lymphoma.
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Affiliation(s)
| | - Andrew J. Specht
- Department of Small Animal Clinical SciencesUniversity of Florida College of Veterinary MedicineGainesvilleFloridaUSA
| | - Victoria Cicchirillo
- Department of Small Animal Clinical SciencesUniversity of Florida College of Veterinary MedicineGainesvilleFloridaUSA
| | | | - Autumn N. Harris
- Department of Small Animal Clinical SciencesUniversity of Florida College of Veterinary MedicineGainesvilleFloridaUSA
- Division of Nephrology, Hypertension, and Renal TransplantationUniversity of Florida College of MedicineGainesvilleFloridaUSA
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2
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Liu S, Wan Y, Hu Z, Wang Z, Liu F. Nephrotic syndrome associated with solid malignancies: a systematic review. BMC Nephrol 2024; 25:215. [PMID: 38965515 PMCID: PMC11225115 DOI: 10.1186/s12882-024-03632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) can occur as a paraneoplastic disorder in association with various types of carcinoma. However, paraneoplastic nephrotic syndrome (PNS) is often misdiagnosed as idiopathic nephrotic syndrome or as an adverse effect of oncology treatment, leading to delayed diagnosis and suboptimal treatment. The characteristics of NS associated with solid malignancies are not yet elucidated. We systematically summarized the clinical data for 128 cases of NS combined with solid malignancies with the aim of informing the clinical management of PNS. METHODS We searched the PubMed database for articles published from the date of inception through to October 2023 using the following keywords: "cancer" or "malignant neoplasms" or "neoplasia" or "tumors" and "nephrotic syndrome", "nephrotic" or "syndrome, nephrotic". All data were extracted from case reports and case series, and the extraction included a method for identifying individual-level patient data. RESULTS A literature search yielded 105 cases of PNS and 23 of NS induced by cancer therapy. The median age at diagnosis was 60 years, with a male to female ratio of 1.8:1. In patients with PNS, manifestations of NS occurred before, concomitantly with, or after diagnosis of the tumor (in 36%, 30%, and 34% of cases, respectively). Membranous nephropathy (49%) was the most prevalent renal pathology and found particularly in patients with lung, colorectal, or breast carcinoma. Regardless of whether treatment was for cancer alone or in combination with NS, the likelihood of remission was high. CONCLUSION The pathological type of NS may be associated with specific malignancies in patients with PNS. Prompt identification of PNS coupled with suitable therapeutic intervention has a significant impact on the outcome for patients.
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Affiliation(s)
- Shuo Liu
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqi Road, Jinan, 250021, China
- The First Faculty of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuchen Wan
- Department of Traditional Chinese Medicine Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, China
| | - Ziyu Hu
- Department of Gynaecology, People's Hospital of Dongying, No. 317 South Dongcheng 1st Road, Dongying, 257091, China.
| | - Zhixue Wang
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqi Road, Jinan, 250021, China
| | - Fenye Liu
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqi Road, Jinan, 250021, China.
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3
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Turcotte AE, Glass WF, Lin JS, Burger JA. Membranous nephropathy in chronic lymphocytic leukemia responsive to ibrutinib: A case report. Leuk Res Rep 2023; 20:100377. [PMID: 37457553 PMCID: PMC10338352 DOI: 10.1016/j.lrr.2023.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Membranous nephropathy (MN) is an uncommon renal presentation in patients with chronic lymphocytic leukemia (CLL), and as such, there is no standard therapy for these patients. A few cases of MN in CLL have been described with varying success in MN treatment involving alkylating agents and fludarabine. Here we report the first case of MN in a patient with CLL treated with ibrutinib with complete renal response. This presentation underlines the importance of recognizing rare glomerular diseases that may occur with CLL and offers a new therapeutic avenue to the treatment of CLL-associated MN.
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Affiliation(s)
- Anna-Eve Turcotte
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - William F. Glass
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center McGovern Medical School, Houston, TX, United States of America
- Division of Anatomic Pathology, Department of Pathology, The University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Jamie S. Lin
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Jan A. Burger
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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4
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Khan MB, Kaur A, Ali A, Boris A, Spitalewitz S. Complete Resolution of Paraneoplastic Membranous Nephropathy Following Curative Therapy of Triple-Negative Breast Cancer. Cureus 2021; 13:e18125. [PMID: 34692335 PMCID: PMC8528167 DOI: 10.7759/cureus.18125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 12/01/2022] Open
Abstract
A paraneoplastic syndrome, which includes glomerulopathy, is a manifestation of malignancy unexplained by direct tumor burden. Membranous nephropathy (MN) may be associated with malignancies that are primarily solid tumors of the lung, prostate and gastrointestinal tract. It is rarely associated with breast cancer. To our knowledge, we herein report the first case of MN associated with triple-negative carcinoma of the breast. The patient initially presented with MN as a paraneoplastic nephrotic syndrome. Treatment resulting in a complete pathological response of the breast cancer also resolved the MN. Neither has recurred after a 48-month follow-up. The patient exhibited autoantibodies against phospholipase A2 receptor and was also antinuclear antibody (ANA) and anti-Smith (anti-Sm) antibody positive. These results suggest that the neoplasm evoked an autoimmune response, which resolved with treatment. ANA and anti-SM positivity closely correlated with the neoplasm activity supporting this hypothesis.
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Affiliation(s)
- Muhammad B Khan
- Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Amandeep Kaur
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Asad Ali
- Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Avezbakiyev Boris
- Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Mizusawa H, Mimura Y, Utazu H, Maejima T. Muscle invasive urinary bladder urothelial carcinoma presenting with secondary nephrotic symptoms. IJU Case Rep 2021; 4:314-317. [PMID: 34497993 PMCID: PMC8413222 DOI: 10.1002/iju5.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/30/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Nephrotic syndrome secondary to malignant disease accounts for approximately 10% of cases of nephrotic syndrome in adults. However, urothelial carcinoma of the bladder is a rare cancer, with only four cases reported to date. CASE PRESENTATION A 76-year-old man presented with chief complaints of edema and anorexia. Laboratory examinations revealed hypoalbuminemia and marked proteinuria, and computed tomography demonstrated multiple bladder tumors. Transurethral resection of the bladder tumors was performed. The pathological diagnosis was urothelial carcinoma with muscular invasion. The patient underwent simple cystectomy and ileal conduit formation, and proteinuria disappeared after 4 weeks. However, urethral recurrence was noted, and he died 35 months after cystectomy. CONCLUSION Five cases including ours were clinically reviewed. Nephrotic symptoms improved relatively rapidly after surgery in all cases. In contrast to the poor preoperative general condition, postoperative improvement can be expected, and surgical treatment should, therefore, be considered.
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Affiliation(s)
- Hiroya Mizusawa
- Department ofUrologyNational Hospital Organization Shinshu Ueda Medical CenterUedaNaganoJapan
| | - Yuji Mimura
- Department ofUrologyNational Hospital Organization Shinshu Ueda Medical CenterUedaNaganoJapan
| | - Haruhiko Utazu
- Department ofUrologyNational Hospital Organization Shinshu Ueda Medical CenterUedaNaganoJapan
| | - Toshitaka Maejima
- Department ofPathology and Laboratory MedicineNational Hospital Organization Shinshu Ueda Medical CenterUedaNaganoJapan
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6
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Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits. Diagnostics (Basel) 2021; 11:diagnostics11040710. [PMID: 33921123 PMCID: PMC8071536 DOI: 10.3390/diagnostics11040710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.
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7
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Higashihara T, Okada A, Nakamura Y, Saigusa H, Homma S, Matsumura M, Kusano T, Shimizu A, Takano H. Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits without Conspicuous Mesangial Proliferation, Complicated with Squamous Cell Lung Carcinoma. Intern Med 2020; 59:557-562. [PMID: 31611527 PMCID: PMC7056369 DOI: 10.2169/internalmedicine.2993-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We performed a renal biopsy for nephrotic syndrome in a patient with squamous cell lung carcinoma, which can worsen the prognosis. Chemoradiation therapy was effective for the cancer and proteinuria; we thus inferred that the nephrotic syndrome had been closely associated with the carcinoma. A pathological analysis of the kidney showed monoclonality for λ chain, satisfying the diagnostic criteria of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID); however, conspicuous mesangial proliferation was not observed. This is the first case of PGNMID complicated with lung carcinoma; furthermore, our findings underscore the importance of examining renal lesions and assessing monoclonality in cancer patients.
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MESH Headings
- Aged
- Antibodies, Monoclonal/blood
- Carcinoma, Non-Small-Cell Lung/complications
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/physiopathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/physiopathology
- Carcinoma, Squamous Cell/radiotherapy
- Cell Proliferation/drug effects
- Epithelial Cells/drug effects
- Glomerulonephritis, Membranoproliferative/diagnosis
- Glomerulonephritis, Membranoproliferative/etiology
- Glomerulonephritis, Membranoproliferative/physiopathology
- Humans
- Immunoglobulin G/blood
- Male
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Affiliation(s)
- Takaaki Higashihara
- Department of Nephrology, Tokyo Teishin Hospital, Japan
- Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
| | - Akira Okada
- Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
| | - Yasuna Nakamura
- Department of Nephrology, Tokyo Teishin Hospital, Japan
- Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
| | - Hanako Saigusa
- Department of Nephrology, Tokyo Teishin Hospital, Japan
- Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
| | - Shiko Homma
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | | | - Taiko Kusano
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Hideki Takano
- Department of Nephrology, Tokyo Teishin Hospital, Japan
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8
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Benabdellah N, Izzedine H, Bentata Y, Haddiya I. Ovarian tumor and glomerulopathies: case report and review of the literature. Pan Afr Med J 2019; 34:75. [PMID: 31819791 PMCID: PMC6884736 DOI: 10.11604/pamj.2019.34.75.6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/15/2019] [Indexed: 11/11/2022] Open
Abstract
We describe a patient who developed nephrotic syndrome in the setting of ovarian tumor. A kidney biopsy showed minimal change nephropathy (MCN). CT scan and MR imaging followed by surgery lead to diagnostic of ovarian dermoid cyst. Surgery combined with corticosteroids resulted in a complete remission of nephrotic syndrome with disappearance of proteinuria after 3 weeks. Ten other cases of ovarian tumor associated with glomerulopathy are reviewed. This is the second case of an ovarian teratoma associated with MCN. Accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.
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Affiliation(s)
- Nawal Benabdellah
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
| | - Hassan Izzedine
- Department of Nephrology, Pitie-Salpetiere Hospital, 43 Boulevard de l'Hôpital, 75013 Paris, France
| | - Yassamine Bentata
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
| | - Intissar Haddiya
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
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9
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Anwar A, Jafri F, Ashraf S, Jafri MAS, Fanucchi M. Paraneoplastic syndromes in lung cancer and their management. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:359. [PMID: 31516905 DOI: 10.21037/atm.2019.04.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Paraneoplastic syndromes are most frequently associated with lung cancer. This review considers a variety of paraneoplastic syndromes associated with lung cancer and discusses their pathophysiology, clinical features and management options.
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Affiliation(s)
- Asad Anwar
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Firas Jafri
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Sara Ashraf
- Department of Hematology/Oncology, Marshall University, Huntington, WV, USA
| | - Mohammad Ali S Jafri
- Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Fanucchi
- Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA
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10
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Javaugue V, Debiais-Delpech C, Nouvier M, Gand E, Chauvet S, Ecotiere L, Desport E, Goujon JM, Delwail V, Guidez S, Tomowiak C, Leleu X, Jaccard A, Rioux-Leclerc N, Vigneau C, Fermand JP, Touchard G, Thierry A, Bridoux F. Clinicopathological spectrum of renal parenchymal involvement in B-cell lymphoproliferative disorders. Kidney Int 2019; 96:94-103. [PMID: 30987838 DOI: 10.1016/j.kint.2019.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 01/25/2023]
Abstract
The clinicopathological characteristics of kidney infiltration in B-cell lymphoproliferative disorders remain poorly described. We retrospectively studied 52 adults with biopsy-proven malignant B-cell kidney infiltration, including Waldenström's macroglobulinemia (n=21), chronic lymphocytic leukemia (n=11), diffuse large B-cell lymphoma (DLBCL) (n=8), other lymphoma (n=11), and multiple myeloma (n=1). Kidney disease varied according to the underlying lymphoproliferative disorder. In DLBCL, malignant kidney infiltration was prominent, resulting in acute kidney injury (AKI, 75%) and kidney enlargement (88%). In the other types, associated immunoglobulin-related nephropathy (most commonly AL amyloidosis) was more common (45%), and chronic kidney disease with proteinuria was the primary presentation. All patients received chemotherapy. Over a median follow-up of 31 months, 20 patients died and 21 reached end-stage kidney disease. Renal response, achieved in 25 patients (48%), was associated with higher overall survival (97 vs. 37 months in non-renal responders). In univariate analysis, percentage of sclerotic glomeruli, kidney enlargement, and complete hematological response at 6 months were predictive of renal response. In multivariate analysis, concomitant immunoglobulin-related nephropathy was the sole independent predictor of poor renal outcome. In conclusion, clinical presentation of renal lymphomatous infiltration depends on the nature of the underlying lymphoproliferative disorder. In DLBCL, massive renal infiltration manifests with enlarged kidneys and AKI, and the diagnosis primarily relies on lymph node biopsy. In other B-cell lymphoproliferative disorders, the clinicopathological spectrum is more heterogeneous, with a high frequency of immunoglobulin-related nephropathy that may affect renal outcome; thus kidney biopsy is required for early diagnosis and prognostic assessment.
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Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Céline Debiais-Delpech
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Mathilde Nouvier
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Elise Gand
- INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| | - Sophie Chauvet
- INSERM UMR 1138, Centre de Recherche des Cordeliers, Complement and Diseases Team, Paris, France; Assistance Publique Hôpitaux de Paris, Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Laure Ecotiere
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Vincent Delwail
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Department of Hematology, Centre Hospitalier Universitaire, Université de Limoges, Limoges, France
| | | | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire, Rennes, France; CNRS UMR 6290, Université Rennes 1, France
| | | | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; INSERM UMR 1082, Centre Hospitalier Universitaire, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
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11
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Kajiwara N, Wada N, Kusumoto T, Akamaru Y, Ohashi H, Hayashi K. Case report: Gastric cancer-associated membranous nephropathy that recurred after complete remission and formation of peritoneal dissemination. Clin Case Rep 2019; 7:515-519. [PMID: 30899484 PMCID: PMC6406138 DOI: 10.1002/ccr3.2002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/12/2018] [Accepted: 12/30/2018] [Indexed: 12/29/2022] Open
Abstract
Membranous nephropathy associated with malignant neoplasm may remit completely with treatment of the underlying disease. In such cases, recurrence is very rare. However, after a recurrence, attention should be paid to the possible recurrence of the underlying disease.
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Affiliation(s)
| | - Noriko Wada
- Department of Gastroenterological SurgeryIkeda City HospitalIkedaJapan
| | - Takuya Kusumoto
- Post Graduate Clinical Education CenterIkeda City HospitalIkedaJapan
| | - Yusuke Akamaru
- Department of Gastroenterological SurgeryIkeda City HospitalIkedaJapan
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12
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Nagayama I, Akimoto T, Ono Y, Ueda Y, Nagata D. Remission of nephrotic syndrome after surgical intervention for bronchogenic carcinoma: the 10-year follow-up of a patient with membranous nephropathy. Int Med Case Rep J 2018; 11:167-171. [PMID: 30104905 PMCID: PMC6071629 DOI: 10.2147/imcrj.s170267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Nephrotic syndrome (NS) is a pivotal manifestation of glomerular injury associated with various types of neoplasms. It may either precede or act as the presenting feature of the disease, whereas membranous nephropathy (MN) is a major phenotype of paraneoplastic glomerulopathies. However, there is a lack of information regarding the remission from paraneoplastic NS due to MN in patients who achieve favorable long-term survival after the successful removal of malignant tissue. We, herein, describe a case of biopsy-proven MN in a 65-year-old male patient with bronchogenic carcinoma, which was found during the systemic workup for concurrent NS. He was successfully treated with thoracoscopic left lower lobectomy and achieved a complete remission from NS at approximately 10 months after radical surgery. In 10 years of follow-up, there has been no recurrence of the pulmonary cancer and the patient is doing well with no relapse of NS, despite having never received treatment with any type of immunomodulating agent. Several concerns, including diagnostic management and therapeutic strategies for paraneoplastic NS, are discussed.
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Affiliation(s)
- Izumi Nagayama
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan,
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan,
- Department of Chronic Kidney Disease Pathophysiology, Jichi Medical University, Shimotsuke, Tochigi, Japan,
| | - Yuko Ono
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan,
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13
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Valcamonico F, Ferrari V, Simoncini E, Gregorini G, Vassalli L, Amoroso V, Marpicati P, Rangoni G, Mambrini A, Marini G. Paraneoplastic Nephrotic Syndrome in Advanced Breast Cancer Patient. A Case Report. TUMORI JOURNAL 2018; 90:154-6. [PMID: 15143992 DOI: 10.1177/030089160409000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of paraneoplastic nephrotic syndrome (NS) is described five years after the diagnosis of breast cancer. A review of the literature shows that NS is a rare complication of breast carcinoma.
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14
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Brown RB, Razzaque MS. Phosphate toxicity and tumorigenesis. Biochim Biophys Acta Rev Cancer 2018; 1869:303-309. [PMID: 29684520 DOI: 10.1016/j.bbcan.2018.04.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
In this article, we briefly summarized evidence that cellular phosphate burden from phosphate toxicity is a pathophysiological determinant of cancer cell growth. Tumor cells express more phosphate cotransporters and store more inorganic phosphate than normal cells, and dysregulated phosphate homeostasis is associated with the genesis of various human tumors. High dietary phosphate consumption causes the growth of lung and skin tumors in experimental animal models. Additional studies show that excessive phosphate burden induces growth-promoting cell signaling, stimulates neovascularization, and is associated with chromosome instability and metastasis. Studies have also shown phosphate is a mitogenic factor that affects various tumor cell growth. Among epidemiological evidence linking phosphate and tumor formation, the Health Professionals Follow-Up Study found that high dietary phosphate levels were independently associated with lethal and high-grade prostate cancer. Further research is needed to determine how excessive dietary phosphate consumption influences initiation and promotion of tumorigenesis, and to elucidate prognostic benefits of reducing phosphate burden to decrease tumor cell growth and delay metastatic progression. The results of such studies could provide the basis for therapeutic modulation of phosphate metabolism for improved patient outcome.
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Affiliation(s)
- Ronald B Brown
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammed S Razzaque
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA; Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda; Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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15
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Affiliation(s)
- P E Stevens
- Department of Renal Medicine, Princess Mary's RAF Hospital, Aylesbury, Bucks
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16
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Aytekin A, Ozet A, Bilgetekin I, Ogut B, Ciltas A, Benekli M. A case of membranous glomerulopathy associated with lung cancer and review of the literature. Mol Clin Oncol 2017; 7:241-243. [PMID: 28781794 DOI: 10.3892/mco.2017.1295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/15/2017] [Indexed: 11/06/2022] Open
Abstract
Membraneous nephropathy (MN) is the most commonly occurring nephrotic syndrome in adults as well as the most common paraneoplastic nephropathy associated with solid tumors, and it is mostly associated with gastrointestinal system and lung carcinomas. Accurate diagnosis is important as the treatment of paraneoplastic glomerulonephritis is very varied from that of idiopathic ones. In the current report, a case of a patient that was referred with proteinuria and edema and was diagnosed with lung cancer, and responded markedly to treatment of malignancy, with improvement of MN, is presented. Active cancer is present in all patients with paraneoplastic MN. In numerous patients, the paraneoplastic MN and cancer diagnoses are made within one year of each other. The treatment of paraneoplastic syndromes is usually associated with the treatment of primary malignancy. There are conflicting data on which treatment modality is more suitable. In conclusion, further studies are required in order to determine the actual incidence of cancer in patients with nephropathy, explain the physiopathological association between cancer and nephropathy and to determine the most suitable treatment approaches.
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Affiliation(s)
- Aydin Aytekin
- Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
| | - Ahmet Ozet
- Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
| | - Irem Bilgetekin
- Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
| | - Betul Ogut
- Department of Pathology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
| | - Aydin Ciltas
- Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
| | - Mustafa Benekli
- Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara 06560, Turkey
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17
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Chan S, Oliver KA, Gray NA. An association between membranoproliferative glomerulonephritis and metastatic colorectal carcinoma: a case report. J Med Case Rep 2016; 10:199. [PMID: 27439394 PMCID: PMC4955154 DOI: 10.1186/s13256-016-0979-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Membranoproliferative glomerulonephritis is a common pattern of glomerular injury in monoclonal gammopathy, but has only rarely been associated with solid organ tumors, mainly lung, renal, gastric, breast, and prostate. There have been two reported cases of membranoproliferative glomerulonephritis associated with adenocarcinoma of the colon and rectum, although the association may be coincidental. We report a case where nephrotic syndrome due to membranoproliferative glomerulonephritis developed in a patient with colorectal carcinoma and elucidate some of the pathophysiological mechanisms underpinning this presentation. CASE PRESENTATION A 54-year-old white man with a history of adenocarcinoma of the colon with metastasis to the liver and ureter presented with a 1-week history of bilateral pedal edema, and worsening hypertension and renal function. A renal biopsy confirmed membranoproliferative glomerulonephritis type I. Curative therapy for the malignancy was not possible, so treatment was commenced with prednisolone with consequential biochemical improvement in renal function and proteinuria, although his serum albumin remained low. CONCLUSIONS This case report illustrates an association between membranoproliferative glomerulonephritis and metastatic colorectal carcinoma and adds to the evidence to consider malignancy to be an underlying pathology among newly diagnosed cases of nephrotic syndrome. In the clinical setting, treatment of the underlying malignancy should be first considered in patients with a tumor presenting with kidney disease which is suspected to be paraneoplastic in etiology.
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Affiliation(s)
- Samuel Chan
- Department of Renal Medicine, Nambour General Hospital, Nambour, Queensland, Australia. .,The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
| | - Kimberley A Oliver
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,Department of Pathology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Nicholas A Gray
- Department of Renal Medicine, Nambour General Hospital, Nambour, Queensland, Australia.,The University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, Queensland, Australia
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19
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Strati P, Nasr SH, Leung N, Hanson CA, Chaffee KG, Schwager SM, Achenbach SJ, Call TG, Parikh SA, Ding W, Kay NE, Shanafelt TD. Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience. Haematologica 2015; 100:1180-8. [PMID: 26088927 DOI: 10.3324/haematol.2015.128793] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/10/2015] [Indexed: 11/09/2022] Open
Abstract
While the renal complications of plasma cell dyscrasia have been well-described, most information in patients with chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis is derived from case reports. This is a retrospective analysis of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who underwent kidney biopsy for renal insufficiency and/or nephrotic syndrome. Between January 1995 and June 2014, 49 of 4,024 (1.2%) patients with chronic lymphocytic leukemia (n=44) or monoclonal B-cell lymphocytosis (n=5) had a renal biopsy: 34 (69%) for renal insufficiency and 15 (31%) for nephrotic syndrome. The most common findings on biopsy were: membranoproliferative glomerulonephritis (n=10, 20%), chronic lymphocytic leukemia interstitial infiltration as primary etiology (n=6, 12%), thrombotic microangiopathy (n=6, 12%), and minimal change disease (n=5, 10%). All five membranoproliferative glomerulonephritis patients treated with rituximab, cyclophosphamide and prednisone-based regimens had recovery of renal function compared to 0/3 patients treated with rituximab with or without steroids. Chronic lymphocytic leukemia infiltration as the primary cause of renal abnormalities was typically observed in relapsed/refractory patients (4/6). Thrombotic microangiopathy primarily occurred as a treatment-related toxicity of pentostatin (4/6 cases), and resolved with drug discontinuation. All cases of minimal change disease resolved with immunosuppressive agents only. Renal biopsy plays an important role in the management of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who develop renal failure and/or nephrotic syndrome.
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Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Samih H Nasr
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nelson Leung
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | | | | | | | - Wei Ding
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Neil E Kay
- Mayo Clinic College of Medicine, Rochester, MN, USA
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20
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Matsunaga M, Miwa K, Oka Y, Ushijima T, Yuge K, Fukahori M, Katagiri M, Akagi Y. Successful treatment with s-1 and oxaliplatin combination therapy in an elderly patient with metastatic colorectal cancer initially presenting with membranous nephropathy. Case Rep Oncol 2015; 8:212-6. [PMID: 26034482 PMCID: PMC4448055 DOI: 10.1159/000382119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The incidence, morbidity, and mortality of colorectal cancer are increasing, largely owing to an increasingly aging population. Additionally, along with the increasing age of cancer patients, the number of patients with various comorbidities such as membranous nephropathy is also rising, and problems associated with the administration of chemotherapy to elderly patients with these conditions are becoming more common. Herein, we describe a case involving an 80-year-old woman who presented with general malaise, edematous limbs, and pleural effusion. An abdominal CT revealed multiple, relatively large, metastatic lesions in a wide area of the liver and left pleural effusion, and she was accordingly diagnosed with membranous nephropathy secondary to ascending colon cancer and multiple liver metastases. Despite her advanced age and the presence of membranous nephropathy, her general condition was favorable and chemotherapy was hence administered. Taking the toxicity profiles and the patient's preference into consideration, S-1 and oxaliplatin (SOX) therapy was selected, which showed a good tolerability. An abdominal CT after 8 cycles of SOX therapy revealed a marked reduction in the metastatic lesions in the liver and a decrease in the left pleural effusion, and the levels of tumor markers also decreased (partial response). At the latest follow-up, after the completion of 16 cycles, the condition of the patient remained stable, without any apparent signs of progressive disease. Based on this case, we conclude that, even for elderly patients with systemic complications or comorbid diseases, standard treatments should be considered after their general conditions, and therapeutic regimens have been sufficiently examined.
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Affiliation(s)
- Mototsugu Matsunaga
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| | - Yosuke Oka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tomoyuki Ushijima
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan ; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kotaro Yuge
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masaru Fukahori
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan ; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Mitsuhiro Katagiri
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan ; Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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21
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Christiansen CF, Onega T, Sværke C, Körmendiné Farkas D, Jespersen B, Baron JA, Sørensen HT. Risk and prognosis of cancer in patients with nephrotic syndrome. Am J Med 2014; 127:871-7.e1. [PMID: 24838191 DOI: 10.1016/j.amjmed.2014.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/13/2013] [Accepted: 05/01/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nephrotic syndrome may be a marker of occult cancer, but population-based studies of this association are lacking. Therefore, we examined the risk and prognosis of cancer in patients with nephrotic syndrome. METHODS We conducted this population-based cohort study in Denmark, including all individuals diagnosed with nephrotic syndrome between 1980 and 2010 without a preceding cancer history. We computed the 5-year risk of cancer accounting for competing risk by death and standardized incidence ratios (SIRs) of cancer in patients with nephrotic syndrome relative to the general population. We compared the 5-year mortality for patients with cancer after nephrotic syndrome with that for a cancer cohort without a history of nephrotic syndrome using Cox regression adjusted for age, gender, and comorbidity. RESULTS Of 4293 individuals with nephrotic syndrome, 338 developed an incident cancer during a median follow-up of 5.7 years. The 5-year risk of any cancer was 4.7% in patients with nephrotic syndrome, a 73% increased risk (SIR, 1.73; 95% confidence interval [CI], 1.55-1.92). The association was most pronounced for lung cancer, kidney cancer, lymphoma, and multiple myeloma. It was highest within 1 year of nephrotic syndrome diagnosis (SIR, 4.49; 95% CI, 3.68-5.42), but remained increased beyond 1 year (SIR, 1.34; 95% CI, 1.17-1.53). The 5-year mortality after cancer was 68.5% in patients with cancer with nephrotic syndrome and 63.4% in the cancer comparison cohort (adjusted hazard ratio, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS Nephrotic syndrome is a marker of occult solid tumors and hematologic malignancies and is associated with a worsened cancer prognosis.
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Affiliation(s)
| | - Tracy Onega
- Departments of Medicine and Community and Family Medicine and the Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, NH
| | - Claus Sværke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John A Baron
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, University of North Carolina, Chapel Hill
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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22
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Crawford AR, Dworkin L, Leonard K, Khurshid H, Hepel JT. Recurrence of paraneoplastic membranous glomerulonephritis following chemoradiation in a man with non-small-cell lung carcinoma. Rare Tumors 2013; 5:62-4. [PMID: 23888216 PMCID: PMC3719111 DOI: 10.4081/rt.2013.e16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/19/2012] [Accepted: 01/16/2013] [Indexed: 11/23/2022] Open
Abstract
Abstract Membranous glomerulonephritis can occur as a rare paraneoplastic complication of human cancers. In this case report, we describe a patient who presented acutely with symptoms of the nephrotic syndrome including heavy proteinuria and anasarca. He was subsequently diagnosed with membranous glomerulonephritis, and soon afterwards was found to have stage IIIB non-small cell lung cancer. Following chemoradiation therapy, both the patient’s cancer and membranous glomerulonephritis dramatically improved. However, approximately 14 months following his initial presentation, the patient was found to have a recurrence of his nephrotic-range proteinuria which corresponded temporally with recurrence of his cancer. We present details of the case and a review of the relevant scientific literature.
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23
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Zachariah PP, Mathew A, Rajesh R, Kurien G, Unni VN. Nephrotic syndrome associated with meningioma. Indian J Nephrol 2013; 23:63-6. [PMID: 23580810 PMCID: PMC3621244 DOI: 10.4103/0971-4065.107214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 58-year-old man presented with recurrent frontal meningioma and nephrotic syndrome. Renal biopsy could not be done in view of the rapid neurological deterioration. The patient underwent surgical resection of the tumor. Within 4 weeks, the edema decreased, serum albumin improved, and proteinuria decreased spontaneously. At three months of followup, the patient had attained complete remission of nephrotic state.
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Affiliation(s)
- P P Zachariah
- Department of Nephrology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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24
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Patient with esophageal cancer showing remission of nephrotic syndrome after esophagectomy: report of a case. Surg Today 2013; 43:1452-6. [PMID: 23463533 DOI: 10.1007/s00595-012-0477-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/31/2012] [Indexed: 10/27/2022]
Abstract
A 73-year-old male patient was admitted to our hospital due to bilateral leg edema and proteinuria in April 2009. After admission, nephrotic syndrome (membranous nephropathy) was diagnosed. At that point, a cancer screening test was performed; however, no abnormalities were noted. Medical treatment with prednisolone and cyclosporine was started, which resulted in the temporary improvement of markers of laboratory data. The patient was re-examined in November of the same year, and esophageal cancer (squamous cell carcinoma, T2N0M0 Stage IIA according to the UICC TNM classification) was detected in the lower thoracic esophagus. Subtotal esophagectomy was performed via right thoracolaparotomy with two-field lymph node dissection. Although the patient's course was complicated by respiratory failure, he was discharged after 38 days. After performing esophagectomy, prompt amelioration of the nephrotic syndrome occurred, allowing the withdrawal of prednisolone and cyclosporine. There has been no recurrence of esophageal cancer or relapse of nephrotic syndrome during a period of 18 months after esophagectomy.
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25
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Kim CS, Choi YD, Choi JS, Bae EH, Ma SK, Kim SW. EBV-positive diffuse large B-cell lymphoma in a patient with primary Sjögren's syndrome and membranous glomerulonephritis. BMC Nephrol 2012; 13:149. [PMID: 23151312 PMCID: PMC3519503 DOI: 10.1186/1471-2369-13-149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sjögren's syndrome is a systemic autoimmune disease in which lymphatic cells destroy the salivary and lacrimal glands. Glomerulonephritis is thought to be a rare occurrence in primary Sjögren's syndrome. Furthermore, concurrent glomerular involvement and lymphoma in patients with Sjögren's syndrome has seldom been reported. CASE PRESENTATION A 52-year-old woman with primary Sjögren's syndrome developed membranous glomerulonephritis and Epstein-Barr virus-positive diffuse large B-cell lymphoma (DLBCL). She was diagnosed with Sjögren's syndrome based on the dry eyes, dry mouth, positive anti-nuclear antibody test, anti-Ro (SS-A) antibody, salivary gland biopsy, and salivary scintigraphy. Moreover, renal biopsy confirmed the diagnosis of membranous glomerulonephritis. Three months later, her small bowel was perforated with pneumoperitoneum, and the biopsy revealed Epstein-Barr virus-positive DLBCL. CONCLUSIONS We observed the first case of primary Sjögren's syndrome associated with Epstein-Barr Virus-positive DLBCL and membranous glomerulonephritis. Because of the possibility of malignancy-associated membranous glomerulonephritis in patients with primary Sjögren's syndrome, we should be careful and examine such patients for hidden malignancy.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea
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26
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Cambier JF, Ronco P. Onco-Nephrology: Glomerular Diseases with Cancer. Clin J Am Soc Nephrol 2012; 7:1701-12. [DOI: 10.2215/cjn.03770412] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Response of paraneoplastic nephrotic syndrome to corticosteroids combined with chemotherapy for advanced lung cancer: a case report and literature review. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Glassock RJ. Attending Rounds: An Older Patient with Nephrotic Syndrome. Clin J Am Soc Nephrol 2012; 7:665-70. [DOI: 10.2215/cjn.12771211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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29
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Kyung CH, Kim SH, Lim BJ, Ko HS, Park HJ, Kim HW, Park DH, Lee JE. A Case of Basal Cell Carcinoma in a Patient with Membranous Glomerulonephritis. Yeungnam Univ J Med 2012. [DOI: 10.12701/yujm.2012.29.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chan Hee Kyung
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
| | - So Hee Kim
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Yousei University College of Medicine, Seoul, Korea
| | - Hee Sung Ko
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
| | - Hee Jin Park
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
| | - Hae Won Kim
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstruction Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jung Eun Lee
- Department of Internal Medicine, Yousei University College of Medicine, Seoul, Korea
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Abstract
An association between the glomerular disease membranous nephropathy (MN) and malignancy has long been appreciated, but evidence supporting this relationship remains limited, speculative, and, at times, controversial. Reports that the two disease processes often evolve in parallel, as well as the occasional findings of tumor antigens or tumor-reactive antibodies within glomerular immune deposits, are all supportive of an association. However, the diagnosis of both MN and malignancy in the same individual also may be coincidental, especially in an older demographic group in which both diseases tend to occur. This article briefly reviews the proposed pathogenetic mechanisms of idiopathic and secondary forms of MN, as well as the arguments for and against the contention that malignancy-associated MN is itself a distinct clinical entity. In addition, the recent identification of the M-type phospholipase A₂ receptor as a major glomerular antigen in idiopathic MN has the potential to offer fresh tools that might help resolve some of the controversy, and ultimately aid in the decision of how aggressively to screen for malignancy in an individual diagnosed with MN.
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Affiliation(s)
- Laurence H Beck
- Department of Medicine, Renal Section, Evans Biomedical Research Center, Boston University School of Medicine, Boston, MA 02118, USA.
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31
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A case with significant proteinuria caused by secreted protein from urothelial carcinoma. Case Rep Nephrol 2011; 2011:373480. [PMID: 24533189 PMCID: PMC3914127 DOI: 10.1155/2011/373480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 10/30/2011] [Indexed: 11/29/2022] Open
Abstract
58-year-old female was admitted to our hospital complaining isolated proteinuria of 1.7 g/day. Abdominal echography showed right-sided unilateral hydronephrosis, and computed tomography pointed out a tumor of the right renal pelvis, suggesting cancer of renal pelvis. The right nephroureterectomy was carried out. Pathological diagnosis was urothelial carcinoma. Renal tissue revealed no apparent glomerulopathy with tubular atrophy, interstitial fibrosis, and mildly-to-moderately interstitial mononuclear cell infiltration. Immunofluorescence study showed no deposition of immunoreactanct, and electron microscopy showed almost normal glomerulus without electron dense deposit. Proteinuria disappeared within 6 days after the operation. Moderate amount of proteinuria in our patient was probably caused by secreted protein from urothelial carcinoma. This condition is rare but should be taken into account in patients with even moderate amount of proteinuria.
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Ito C, Akimoto T, Nakazawa E, Komori S, Sugase T, Chinda J, Takahashi H, Ioka T, Muto S, Kusano E. A case of cervical cancer-related membranous nephropathy treated with radiation therapy. Intern Med 2011; 50:47-51. [PMID: 21212573 DOI: 10.2169/internalmedicine.50.4341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Paraneoplastic nephropathy is a rare complication of malignant disease. We present a case of cervical cancer with biopsy-proven membranous nephropathy and associated nephrotic syndrome. Irradiation to the specific neoplasm site and to the metastatic paraaortic lymph node tissues lead to regression of the nephrotic syndrome without causing severe adverse events. Radiation therapy can be the first choice in the treatment of paraneoplastic nephrotic syndrome if the primary neoplasm is unresectable. Invasiveness of intervention and patient prognosis should be carefully deliberated in the management of the two diseases.
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Affiliation(s)
- Chiharu Ito
- Division of Nephrology, Department of Medicine, Jichi Medical School, Japan.
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Faria TV, Baptista MAF, Burdman EDA, Cury P. Glomerular deposition of immune complexes as a first manifestation of malignant melanoma – a case report. Ren Fail 2010; 32:1223-5. [DOI: 10.3109/0886022x.2010.516852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cohen LJ, Rennke HG, Laubach JP, Humphreys BD. The spectrum of kidney involvement in lymphoma: a case report and review of the literature. Am J Kidney Dis 2010; 56:1191-6. [PMID: 20843590 DOI: 10.1053/j.ajkd.2010.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/01/2010] [Indexed: 11/11/2022]
Abstract
Kidney involvement is an under-recognized complication of both Hodgkin and non-Hodgkin lymphoma. The diversity of lymphoma-related renal manifestations makes diagnosis difficult. Although abrupt worsening of kidney function may be the first sign of malignant disease, renal effects can be subtle or even silent. The causes of renal involvement similarly are varied. We discuss a case of non-Hodgkin lymphoma and associated kidney failure from several distinct malignancy-related mechanisms and review the spectrum of lymphoma-related kidney involvement.
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Affiliation(s)
- Lisa J Cohen
- Nephrology Division, Brigham and Women's Hospital, Boston, MA, USA.
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35
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Faria TV, Baptista MAF, Burdmann EA, Cury PM. Renal glomerular alterations in patients with cancer: a clinical and immunohistochemical autopsy study. Ren Fail 2010; 32:918-22. [DOI: 10.3109/0886022x.2010.502278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tamara Veiga Faria
- Department of Pathology, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.
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36
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Adamidis KN, Metaxatos G, Hadjiconstantinou V. Splenic Marginal Lymphoma and Glomerulonephritis: Case Report and Review of the Literature. Ren Fail 2010; 32:281-5. [DOI: 10.3109/08860220903552132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Uramatsu T, Furusu A, Nishino T, Obata Y, Kanamoto Y, Komuro S, Ito M, Taguchi T, Kohno S. Membranous nephropathy complicating nasopharyngeal carcinoma. Intern Med 2010; 49:585-8. [PMID: 20228596 DOI: 10.2169/internalmedicine.49.2762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 38-year-old woman diagnosed with nephrotic syndrome. Steroid pulse therapy and mizoribine was started in late October 2002 and continued for about 10 months, but no apparent therapeutic effect was obtained. During this period, the patient was diagnosed with nasopharyngeal carcinoma. As nephrotic syndrome did not improve, renal biopsy was performed and membranous nephropathy (MN) was diagnosed. After resection of nasopharyngeal carcinoma was performed, the urinary protein level decreased rapidly. Since MN caused by nasopharyngeal carcinoma is very rare, this represents an interesting case of malignancy-associated MN.
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Affiliation(s)
- Tadashi Uramatsu
- Second Department of Internal Medicine, Nagasaki University School of Medicine
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38
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Henriksen KJ, Meehan SM, Chang A. Nonneoplastic kidney diseases in adult tumor nephrectomy and nephroureterectomy specimens: common, harmful, yet underappreciated. Arch Pathol Lab Med 2009; 133:1012-25. [PMID: 19642728 DOI: 10.5858/133.7.1012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Nonneoplastic kidney diseases, such as arterionephrosclerosis and/or diabetic nephropathy, are commonly encountered in tumor nephrectomy and nephroureterectomy specimens. Although any nonneoplastic kidney disease may be encountered in these resection specimens by chance, additional diseases that may be related to the underlying neoplasm or its treatment regimen include thrombotic microangiopathy, Amyloid A amyloidosis, membranous nephropathy, immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, pauci-immune crescentic glomerulonephritis, focal segmental glomerulosclerosis, minimal-change disease, acute interstitial nephritis, and xanthogranulomatous pyelonephritis. Given the morbidity of chronic kidney disease and the relatively favorable 5-year survival rates for urothelial and renal cell carcinomas, accurate evaluation of the nonneoplastic kidney parenchyma is important. OBJECTIVES We will discuss our approach for evaluating the nonneoplastic kidney parenchyma in tumor nephrectomy and nephroureterectomy specimens. The pathologic features of the aforementioned kidney diseases as well as pertinent references will be reviewed. The identification of glomerular abnormalities, including mesangial sclerosis or hypercellularity, segmental sclerosis, crescent formation, glomerulitis, or glomerular basement membrane alterations, should lead to additional immunofluorescence and electron microscopic studies. Safeguards to ensure that the nonneoplastic parenchyma is not overlooked include adding this important parameter to synoptic reports and obtaining periodic acid-Schiff and/or Jones methenamine silver stains prior to microscopic evaluation of the neoplasm. DATA SOURCES Relevant literature and University of Chicago Medical Center pathology archives. CONCLUSIONS The practicing surgical pathologist should be aware of the importance of both correctly classifying the resected renal or urothelial neoplasm and the concomitant nonneoplastic kidney disease that may be present in these specimens.
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Affiliation(s)
- Kammi J Henriksen
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
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Clajus C, Spiegel J, Bröcker V, Chatzikyrkou C, Kielstein JT. Minimal change nephrotic syndrome in an 82 year old patient following a tetanus-diphteria-poliomyelitis-vaccination. BMC Nephrol 2009; 10:21. [PMID: 19656382 PMCID: PMC2738668 DOI: 10.1186/1471-2369-10-21] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 08/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most common cause of idiopathic nephrotic syndrome in children and younger adults is the minimal change nephrotic syndrome (MCNS). In the elderly MCNS is relatively uncommon. Over the last decade some reports suggest a rare but possible association with the administration of various vaccines. CASE PRESENTATION A 82-year old Caucasian female presented with pronounced nephrotic syndrome (proteinuria of 7.1 g/d, hypoproteinemia of 47 g/l). About six weeks prior to admission, she had received a combination vaccination for tetanus, diphtheria and poliomyelitis as a booster-vaccination from her general practitioner. The renal biopsy revealed typical minimal change lesions. She responded well to the initiated steroid treatment. As through physical examination as well as extensive laboratory and imaging studies did neither find any evidence for malignancies nor infections we suggest that the minimal change nephrotic syndrome in this patient might be related to the activation of the immune system triggered by the vaccination. CONCLUSION Our case as well as previous anecdotal reports suggests that vaccination and the resulting stimulations of the immune system might cause MCNS and other severe immune-reactions. Increased awareness in that regard might help to expand the database of those cases.
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Affiliation(s)
- Christian Clajus
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany.
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40
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Cimic A, Pastan SO, Bijol V. Membranous nephropathy associated with gastrointestinal stromal tumour: a case report. NDT Plus 2009; 2:306-8. [PMID: 25984023 PMCID: PMC4421245 DOI: 10.1093/ndtplus/sfp028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 12/28/2022] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in older adults. The association of MN with neoplasia has been controversial, but several recent studies have shown increase incidence of cancer in patients with MN [1]. We report a case of a 49-year-old male with severe nephrotic syndrome and concomitant jejunal gastrointestinal stromal tumour (GIST). The combination of preoperative Imatinib mesylate chemotherapy and tumour excision was followed by complete resolution of proteinuria within 19 months, without specific treatment for MN. An association between MN and GIST has never previously been reported in the literature.
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Affiliation(s)
- Adela Cimic
- Department of Pathology, Emory University Hospital
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Vanesa Bijol
- Department of Pathology, Emory University Hospital
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41
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Abstract
Paraneoplastic nephrotic syndrome has been reported in various malignancies: malignant lymphoma, colon cancer, lung cancer, and prostate cancer. Of these, lung cancer is the most commonly associated with the syndrome. Here, we report 4 cases of nephrotic syndrome associated with lung cancer, in one of which urinary protein and edema were improved by steroid therapy. These results suggest that in patients with paraneoplastic nephrotic syndrome histologically diagnosed as having minimal change disease (MCD), it is important not only to treat the cancer itself but also to use steroids as early as possible. On the other hand, our results also showed that treatment is still difficult for locally advanced or metastatic tumors. Therefore, when we encounter patients with nephrotic syndrome, it is important to be aware of the association of nephrotic syndrome and lung cancer.
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Affiliation(s)
- Gen Ohara
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba.
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42
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Bacchetta J, Juillard L, Cochat P, Droz JP. Paraneoplastic glomerular diseases and malignancies. Crit Rev Oncol Hematol 2008; 70:39-58. [PMID: 18790651 DOI: 10.1016/j.critrevonc.2008.08.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 07/15/2008] [Accepted: 08/13/2008] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic glomerulopathies are rare manifestations of neoplastic disease to be distinguished from iatrogenic renal damage. Solid tumors are preferentially associated with membranous nephropathy, whereas Hodgkin's lymphomas are associated with minimal change disease. The most common neoplasia associated with paraneoplastic glomerular disease are carcinomas of the lung and of the gastrointestinal tract. Nephrotic syndrome is the most frequent presentation of paraneoplastic glomerulopathy and the most critical glomerular disease regarding prognosis and patient care. Renal biopsy is recommended in patients with glomerular proteinuria or nephrotic syndrome and cancer, depending on life expectancy and therapeutic options. The primary treatment must be directed at the cancer in all cases. Symptomatic treatment of the nephrotic syndrome with diuretics and ACE inhibitors is justified. Prevention of nephrotic syndrome complications, i.e. thromboses and infections, should also be addressed and systematic regular renal follow-up is warranted. All treatments should be regularly reviewed to avoid toxicity, associated renal function loss or low albumin levels for patients receiving albumin-binding drugs. Epidemiologic studies have low evidence-based value. There is no widely accepted experimental model of the association of glomerulopathy and cancer. Thus, epidemiologic and mechanistic studies are needed to determine the true prevalence of paraneoplastic glomerulopathies and investigate new pathophysiologic approaches.
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Affiliation(s)
- Justine Bacchetta
- Reference Centre for Rare Renla Diseases, Hôpital Femme Mère Enfant, Bron F-69600, France.
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43
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Focal segmental glomerulosclerosis and nephrotic syndrome in a child with embryonal rhabdomyosarcoma. Clin Exp Nephrol 2008; 12:144-148. [DOI: 10.1007/s10157-007-0015-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 09/27/2007] [Indexed: 11/26/2022]
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44
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Yangui I, Msaad S, Smaoui M, Makni S, Kammoun K, Khébir A, Boudawara T, Ayoub A. [Small-cell lung cancer and rapidly fatal nephritic syndrome]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:331-334. [PMID: 18166938 DOI: 10.1016/s0761-8417(07)74212-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.
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Affiliation(s)
- I Yangui
- Service de Pneumo-Allergologie, CHU Hedi-Chaker, Sfax 3029, Tunisia.
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45
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Bjørneklett R, Vikse BE, Svarstad E, Aasarød K, Bostad L, Langmark F, Iversen BM. Long-term risk of cancer in membranous nephropathy patients. Am J Kidney Dis 2007; 50:396-403. [PMID: 17720518 DOI: 10.1053/j.ajkd.2007.06.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/13/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a well-known association between membranous nephropathy (MN) and cancer, and patients with MN usually are examined for cancer at the time of diagnosis. The long-term risk of cancer after MN is not well studied. STUDY DESIGN Cohort study with record linkage between the Norwegian Kidney Biopsy Registry and Norwegian Cancer Registry. SETTING & PARTICIPANTS 161 patients with MN from 1988 to 2003. PREDICTOR Patients with MN compared with the age- and sex-adjusted general Norwegian population. OUTCOMES Cancer diagnosis reported through 2003. RESULTS Mean duration of follow-up was 6.2 years (range, 0.1 to 15 years). 33 patients developed cancer; including 24 patients with cancer after the diagnosis of MN. Median time from diagnosis of MN to diagnosis of cancer was 60 months (range, 0 to 157 months). Mean annual incidence ratio of cancer was 2.4/100 person-years (2.1/100 person-years in the 0- to 5-year period and 2.8/100 person-years for the 5 to 15 years after kidney biopsy). During the 0 to 15 years after the diagnosis of MN, the expected number of cancers was 10.7, resulting in a standardized incidence ratio of cancer of 2.25 (95% confidence interval, 1.44 to 3.35). In the 5 to 15 years after diagnosis, standardized incidence ratio was 2.30 (95% confidence interval, 1.19 to 4.02). Patients with MN who developed cancer were older (65 versus 52 years; P < 0.001). Patients with cancer and MN had a greater mortality rate than patients without cancer (67% versus 26%; P < 0.001). LIMITATIONS Follow-up treatment after MN with cytotoxic and immunosuppressive medications is not known. CONCLUSIONS An increased risk of developing cancer is observed after the diagnosis of MN, which persists for many years.
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Affiliation(s)
- Rune Bjørneklett
- The Norwegian Kidney Biopsy Registry, Haukeland University Hospital, Bergen, Norway
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46
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Affiliation(s)
- N Lameire
- University Hospital Ghent, 4K4 De Pintelaan 185, 9000 Gent, Belgium.
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47
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Khositseth S, Kanitsap N, Warnnissorn N, Thongboonkerd V. IgA nephropathy associated with Hodgkin's disease in children: a case report, literature review and urinary proteome analysis. Pediatr Nephrol 2007; 22:541-6. [PMID: 17143626 DOI: 10.1007/s00467-006-0382-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 10/17/2006] [Accepted: 10/24/2006] [Indexed: 11/27/2022]
Abstract
We report herein a rare case of IgAN associated with Hodgkin's disease in a 14-year-old boy. Clinical manifestations and laboratory parameters were improved after treatment with CHOP chemotherapy and enalapril. Urinary proteins were isolated and examined using state-of-the-art proteomic technology, before and during the treatment course. Two-dimensional gel electrophoresis showed obvious alterations in the urinary proteome profile in response to such therapy. Quantitative intensity analysis and gel mapping revealed 14 altered proteins with reduced excretion levels during the treatment course, including albumin, albumin complexed with decanoic acid, alpha-1 antitrypsin, cadherin-11 precursor, collagen alpha 1 (VI) chain precursor, complement C1q tumor necrosis factor-related protein, Ig heavy chain, Ig light chain, kininogen, inter-alpha-trypsin inhibitor (alpha-1 microglobulin), inter-alpha-trypsin inhibitor heavy chain, leucine-rich alpha-2 glycoprotein, beta-2 microglobulin, and transferrin precursor. Their potential roles in the pathogenesis and pathophysiology of IgAN are discussed.
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Affiliation(s)
- Sookkasem Khositseth
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Bangkok, Thailand
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48
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Lefaucheur C, Stengel B, Nochy D, Martel P, Hill GS, Jacquot C, Rossert J. Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association. Kidney Int 2006; 70:1510-7. [PMID: 16941021 DOI: 10.1038/sj.ki.5001790] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The association between membranous nephropathy (MN) and cancer is often mentioned in textbooks but poorly substantiated, and the characteristics of cancer-associated MN are unknown. To address these questions, we studied a cohort of 240 patients with MN, among them 24 had malignancy at the time of renal biopsy or within a year thereafter. The incidence of cancer was significantly higher in these patients than in the general population (standardized incidence ratio 9.8 [5.5-16.2] for men and 12.3 [4.5-26.9] for women). The frequency of malignancy increased with age. At the time of diagnosis, clinical presentation did not differ between the patients with cancer-associated MN and those with idiopathic MN, but smoking was more frequent among patients with cancer. Analysis of renal biopsies revealed that the number of inflammatory cells infiltrating the glomeruli was significantly higher in patients with cancer-associated MN (P = 0.001). The best cutoff value for distinguishing malignancy-related cases from controls was eight cells per glomerulus. Using this threshold led to a diagnosis of cancer-associated MN with a specificity of 75% and a sensitivity of 92%. In patients with cancer-associated MN, there was a strong relationship between reduction of proteinuria and clinical remission of cancer (P < 0.001). In conclusion, our study provides epidemiologic evidence of an excess of cancer risk in patients with MN. It also shows that age, smoking, and the presence of glomerular leukocytic infiltrates strongly increase the likelihood of malignancy in MN patients.
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Affiliation(s)
- C Lefaucheur
- Paris-Descartes University School of Medicine, Paris, France
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49
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Dauchy FA, Etienne G, Deminière C, Combe C, Merville P, Longy-Boursier M. [Lymphoma with initial renal involvement: four cases]. Rev Med Interne 2006; 27:909-15. [PMID: 16952412 DOI: 10.1016/j.revmed.2006.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 07/06/2006] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a comprehensive description of the clinical features of patients with renal manifestations during lymphoma. METHODS Retrospective review of medical records from all patients diagnosed with lymphoma associated with kidney involvement in our hospital between 1996 to 2004. Four cases were identified and analysed. RESULTS Four patients presented a non-Hodgkin's lymphoma. One patient showed intravascular large B-cell lymphoma, revealed by proteinuria. Another patient had a nephrotic syndrome, and two had a renal mass. Renal histology allowed diagnosis of lymphoma in 3 cases. CONCLUSION The diagnosis of lymphoma associated with renal involvement is rather difficult, and more specifically in case of intravascular large B-cell lymphoma, or even primary renal lymphoma. We present here a comprehensive review of the literature and we discuss pathogenesis of these conditions.
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Affiliation(s)
- F-A Dauchy
- Médecine interne et maladies tropicales, hôpital Saint-André, CHU de Bordeaux, université Bordeaux-II, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
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50
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Audard V, Larousserie F, Grimbert P, Abtahi M, Sotto JJ, Delmer A, Boue F, Nochy D, Brousse N, Delarue R, Remy P, Ronco P, Sahali D, Lang P, Hermine O. Minimal change nephrotic syndrome and classical Hodgkin's lymphoma: Report of 21 cases and review of the literature. Kidney Int 2006; 69:2251-60. [PMID: 16672913 DOI: 10.1038/sj.ki.5000341] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Minimal change nephrotic syndrome (MCNS) is described as a paraneoplastic manifestation of classical Hodgkin's lymphoma (cHL). We reassessed the pathophysiological and clinical significance of this association. A retrospective study was performed to evaluate a cohort of adult patients who developed MCNS and cHL. Twenty-one patients recruited in 15 French centers were analyzed. cHL was associated with inflammatory and general symptoms in most cases. The morphological subtype was predominantly nodular sclerosis (71.4%). MCNS appeared before the diagnosis of lymphoma in eight patients (38.1%) and in this case, it was characterized by a nephrotic syndrome (NS) frequently resistant (50%) or dependent (12.5%) to steroid treatment. Interestingly, diagnosis (3-120 months after MCNS) and effective treatment of the hemopathy were associated with the disappearance of the MCNS. cHL was diagnosed before MCNS in nine patients (42.9%), and in this case, glomerulopathy was associated with cHL relapse in 55.5% of cases. In four patients (19%), the two diseases occurred simultaneously. Extensive immunohistochemical study of lymph nodes was performed in eight patients and did not reveal particular features. In conclusion, MCNS associated with cHL is frequently dependent or resistant to steroid regimen, but remission of NS is obtained with the cure of lymphoma.
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Affiliation(s)
- V Audard
- Department of Nephrology, Henri Mondor Hospital, Paris 12 University, Creteil, Paris, France
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