ArticlePDF Available

Nephrotic syndrome and mesenteric infarction secondary to metastatic mesothelioma

Authors:
Chris Farmer at University of Kent
Chris Farmer
David J Goldsmith at St George's, University of London
David J Goldsmith
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

Malignant mesothelioma can present insidiously with progressive breathlessness and chest pain. Paraneoplastic, or non-chest related, presentations are very rare. The case of an elderly man with occupational exposure to asbestos who presented with nephrotic syndrome due to minimal change nephropathy in the context of advanced pleural mesothelial malignancy is reported.
Figures - uploaded by David J Goldsmith
Author content
All figure content in this area was uploaded by David J Goldsmith
Content may be subject to copyright.
Content uploaded by David J Goldsmith
Author content
All content in this area was uploaded by David J Goldsmith on Feb 20, 2014
Content may be subject to copyright.
Nephrotic syndrome and mesenteric infarction
secondary to metastatic mesothelioma
CKTFarmer, D J A Goldsmith
Abstract
Malignant mesothelioma can present in-
sidiously with progressive breathlessness
and chest pain. Paraneoplastic, or non-
chest related, presentations are very rare.
The case of an elderly man with occupa-
tional exposure to asbestos who presented
with nephrotic syndrome due to minimal
change nephropathy in the context of
advanced pleural mesothelial malignancy
is reported.
(Postgrad Med J 2001;77:333–334)
Keywords: malignant mesothelioma; minimal change
nephropathy; nephrotic syndrome
Case report
In la te 1997 a 66 year old retired man was
admitted with a short but rapidly progressive
history of peripheral oedema, exertional breath-
lessness, and extreme fatigue. He was hypoten-
sive (90/60 mm Hg), breathless at rest, and
pale, with decreased left chest wall movements,
bilateral basal inspiratory crepitations, and
anasarca. Investiga tions sho wed proteinuria of
30.0 g/l, plasma albumin of 15 g/l, haemoglobin
112 g/l, erythrocyte sedimentation rate 110
mm/hour, and plasma creatinine 115 µmol/l.
He had been a telephone engineer until
1994, and undoubtedly exposed to asbestos.
He had a strong family history of raised choles-
terol, myocardial infarction, and thyroid dis-
ease. He had been perfectly well until 1994
when he was admitted with a myocardial
infarction for which he was given streptokinase.
He remained hypotensive and required ino-
tropic support for 18 days during which time
he developed haemoptysis, left lung pneumo-
nia, and a right tension pneumothorax. Eventu-
ally he left hospital, but remained unwell with
intermittent left heart failure and angina. An
angiotensin converting enzyme inhibitor,
antianginals, and diuretics were started. A
small left sided pleural reaction/eVusion re-
mained visible on the chest radiograph.
In early 1997 he was referred for a
respiratory opinion with a recent history of two
upper respiratory tract infections and progres-
sive breathlessness. The chest radiograph
showed extensive left pleural and parenchymal
shadowing. Sputum cytology was normal. Pul-
monary function testing showed a mild ob-
structive pattern. Fibreoptic bronchoscopy was
normal. High resolution computed tomogra-
phy of the chest was thought to show pleural
pathology and basal interstitial pulmonary
fibrosis (fig 1). Rheumatoid factor was noted to
be positive (1/320 titre). A trial of prednisolone
40 mg was started but with no benefit. He
became unwell with nephrotic syndrome and
was referred for a renal opinion.
He was given intravenous diuretic and 20%
albumin. A chest radiograph showed extensive
pleural reaction/eVusion on the left, and a
smaller eVusion on the right. Renal ultrasound
showed two normal sized non-obstructed
kidneys with preserved corticomedullary dif-
ferentiation. Echocardiography showed a di-
lated left ventricle with globally poorly function
and with apical thrombus. Investigations for
autoimmune and plasma cell disease were
negative. Blood clotting studies were normal.
Fibrinogen concentrations were raised (8.6 g/l;
normal range 2.0–4.0 g/l). Renal biopsy
showed 10 glomeruli that were normal on light
microscopy. Sirius red staining for amyloid was
negative. Immunofluorescence was negative.
Electron microscopy showed extensive foot
process fusion and no evidence of immune
deposits. A diagnosis of nephrotic syndrome
secondary to minimal change nephropathy
(MCN) was made and he was started on oral
40 mg prednisolone daily, 150 mg ranitidine
twice a day, and intravenous hepar in then oral
warfarin (48 hours after the renal biopsy)
because of the echocardiographic findings of
apical thrombus and the significant thrombotic
tendency seen in severe nephrotic syndrome.
Shortly afterwards he had a small haemate-
mesis with mild epigastric tenderness. Endo-
scopy show ed mild distal oesophagitis and old
gastritis but no bleeding point and no duodenal
pathology. Anticoagulation was immediately
reversed. However, he developed acute small
bow el obstruction as shown by increasing
abdominal pain, left iliac fossa tenderness,
abdominal distension, faeculent vomiting, ob-
structive bow el sounds, and dilated small bowel
loops on abdominal radiography. Serum amy-
lase was normal. The haemoglobin concentra-
tion was stable at this stage. He rapidly became
more breathless and h ypotensive, required elec-
tive controlled intubation and mechanical venti-
lation with inotropic circulatory support, and
died on the intensive care unit six hours later .
At postmortem examination the left pleural
space was obliterated by old adhesions and by
Figure 1 High resolution computed tomography of the
chest.
Postgrad Med J 2001;77:333–334 333
Renal Unit, 4th Floor
Thomas Guy House,
Guy’s Hospital,
London SE1 9RT, UK
CKTFarmer
D J A Goldsmith
Correspondence to:
Dr Goldsmith
David.goldsmith@gstt.sthames.
nhs.uk
Submitted 5 June 2000
Accepted 2 October 2000
www.postgradmedj.com
yellow tumour plaques. The left upper lobe was
largely replaced by tumour. The right lung was
free from tumour but congested. There were
two tumour nodules on the inner surface of the
pericardial sac. There was old fibrosis of the
septal and anterior left ventricular wall, but no
changes of recent myocardial infarction and no
intracardiac thrombus. Coronary arteries
showed diVuse severe calcific atheroma, but no
recent plaque rupture or thrombosis. The aorta
also showed atheromatous changes. The ab-
dominal cavity contained 400 ml of blood
stained ascites. The 90 cm of distal duodenum
and proximal jejunum were infarcted, and con-
tained fresh blood. There wasa1cmhaemor-
rhagic tumour nodule in the lateral wall of the
anterior horn of the right lateral ventricle.
Histology of the pleural, pericardial, and
brain nodules showed sheets of tumour cells
(fig 2), with areas of spindle cells and also epi-
thelioid cells. The spindle cells stained strongly
positively for cytokeratin. The conclusion was
that the tumour was a sarcomatous pattern
mesothelioma.
Discussion
Renal lesions in the context of malignancy
(both carcinoma and lymphoma) have been
recognised for more than three decades. These
are typically of membranous nephropathy, and
more rarely, renal amyloidosis, mesangiocapil-
lary glomerulonephritis, renal vasculitis (an-
tineutrophil cytoplasmic antibody positive and
negative), and MCN.
1
The development of
membranous nephropathy, an immune com-
plex mediated form of glomerular injury, in
patients with malignant tumours has been pro-
posed to be the result of deposition of tumour
antigens and antitumour antibodies in the
glomerulus, or to changes wrought by the
malignancy on the immune system engender-
ing greater susceptibility to such immune com-
plex mediated damage from exogenous or
endogenous antigens. While initial reports sug-
gested as much as 10% of membranous neph-
ropathy was secondary to underlying malig-
nancy, this figure is now thought to be a
significant overestimate of the true frequency.
The best known association between malig-
nancy and MCN is that seen in Hodgkin’s
lymphoma.
2
Possible mechanisms to explain
the association include the elaboration of
vascular permeability factor, cytokines, and
chemokines by tumour cells.
Renal lesions in the context of pleural
mesothelioma are extremely unusual—only
five cases of nephrotic syndrome with mesothe-
lioma exist in the literature
3–7
of which only one
showed MCN and mesothelioma.
4
In that case,
treatment of nephrotic syndrome with pred-
nisolone and cyclophosphamide was ineVec-
tive, while subsequent treatment of the pleural
tumour with doxorubicin and dacarbazine was
ineVective against the tumour but improved
the patient’s nephrotic syndrome.
Metastatic mesothelioma is exceptionally
unusual, but has been reported.
8–10
The prior
lung problems in this patient (pulmonary
oedema, pneumonia, and contralateral pneu-
mothorax) hindered the diagnosis until late in
the course of the illness.
The cause of the infarction of the duodenum
and jejunum was not clear. The options include
embolisation from the heart (antemortem
echocardiography had shown extensive left
ventricular apical thrombus but none was seen
postmortem), arterial thrombosis (rare but well
documented in nephrotic syndrome
11
), athero-
embolism from an ulcerated aortic plaque,
12
or
hypotensive/watershed infarction on the back-
ground of aortic/mesenteric atheroma. The
prothrombotic tendency in severe nephrotic
syndrome is well described
13
and anticoagula-
tion recommended.
In summary we present a case of MCN in
association with metastatic pleurally based
sarcomatous mesothelioma.
The authors would like to thank Dr Kirkham, Consultant
Histopathologist, Royal Sussex County Hospital, Brighton,
Sussex.
1 Ahmed M, Solangi K, Abbi R, et al. Nephrotic syndrome,
renal failure, and renal malignancy: an unusual tumor-
associated glomerulonephritis. J Am Soc Nephrol
1997;8:848–52.
2 Cavalli F. Rare syndromes in Hodgkin’s disease [see
comments]. Ann Oncol 1998;suppl 5:S109–13.
3 Paliszewska L, Hebanowski M, Szelezynski K. Dwa
przypadki zespolu nerczycowego w przebiegu chorob
nowotworowych [2 cases of nephrotic syndrome in the
course of neoplastic disease]. Pol Tyg Lek 1977;32:1367–8.
4 Schroeter NJ, Rushing DA, Parker JP, et al. Minimal-change
nephrotic syndrome associated with malignant mesothe-
lioma. Arch Intern Med 1986;146:1834–6.
5 Venzano C, Di Marco E, Garbero M, et al. Nephrotic
syndrome associated with pleural mesothelioma. An unu-
sual paraneoplastic event. Recenti Prog Med 1990;81:325–6.
6 Tanaka S, Oda H, Satta H, et al. Nephrotic syndrome asso-
ciated with malignant mesothelioma [letter]. Nephron 1994;
67:510–11.
7 Galesic K, Bozic B, Heinzl R, et al. Pleural mesothelioma
and membranous nephropathy. Nephron 2000;84:71–4.
8 Chung CM, Chu PH, Chen JS, et al. Primary pericardial
mesothelioma with cardiac tamponade and distant metasta-
sis. Chang Keng I Hsueh Tsa Chih 1998;21:498–502.
9 Ishiyama Y, Hisanaga S, Asada Y, et al. Malignant mesothe-
lioma of the pleura with a large tumor embolus in the left
atrium: an autopsy case. Intern Med 1998;37:614–17.
10 Kawai A, Nagasaka Y, Muraki M, et al. Brain metastasis in
malignant pleural mesothelioma. Intern Med 1997;36:591–4.
11 Khatri VP, Fisher JB, Granson MA. Spontaneous arterial
thrombosis associated with nephrotic syndrome: case report
and review of the literature. Nephron 1995;71:95–7.
12 Carnevale NJ, Delany HM. Cholesterol embolization to the
cecum with bowel infarction. Arch Surg 1973;106:94–6.
13 Hong SY, Yang DH. Lipoprotein(a) levels and fibrinolytic
activity in patients with nephrotic syndrome. Nephron 1995;
69:125–30.
Figure 2 Histology showing sheets of tumour cells with areas of spindle cells and also
epithelioid cells.
334 Farmer, Goldsmith
www.postgradmedj.com
... In the present case, whether malignant mesothelioma was involved in the development of nephrotic syndrome remains unclear. However, a review of the English literature identified seven reported cases of malignant mesothelioma associated with nephrotic syndrome (3)(4)(5)(6)(7)(8)(9). Among these seven cases, the primary site of mesothelioma was the pleura in five cases, peritoneum in one case and tunica vaginalis testis in one case. ...
... Solid tumors, such as lung cancer and colon cancer, are considered to be responsible for 5-10% of cases of membranous nephropathy in adults (9). Malignancy associated with membranous nephropathy may occur 12-18 months before, simultaneously with or 12-18 months after the manifestations of membranous glomerulopathy first appear (6). In the present case, malignant pleural mesothelioma became apparent and was diagnosed 20 months after the initial presentation. ...
... Tumor antigens are presumably deposited in the glomeruli, followed by antibody deposition and complement activation, thus leading to epithelial cell and basement membrane injury and proteinuria due to the associated increase in glomerular permeability (6). In contrast with paraneoplastic membranous nephropathy, minimal-change glomerular disease is the most common glomerulopathy associated with lymphoproliferative malignancies, such as Hodgkin's disease, and is thought to be a disorder of the T-cell function (3). ...
An Autopsy Case of Malignant Pleural Mesothelioma Associated with Nephrotic Syndrome
Article
Full-text available
  • Feb 2014
  • INTERNAL MED
A 64-year-old man who had been exposed to asbestos was referred to our hospital for a detailed examination of left pleural effusion. A laboratory examination of the urine and blood revealed nephrotic syndrome. A thoracoscopic examination did not yield a definitive diagnosis. Twenty months later, a left pleural tumor became apparent, and the patient died of respiratory failure and cachexia. An autopsy revealed epithelioid malignant pleural mesothelioma. The glomeruli appeared normal under light microscopy. A review of the English literature revealed only three reports of malignant mesothelioma associated with minimal-change nephrotic syndrome. The natural course of malignant mesothelioma with nephrotic syndrome has not been previously reported.
View
... Nephrotic syndrome is rarely associated with malignant pleural mesothelioma but is well-known to be induced as a paraneoplastic syndrome [1]. Although not leading to any cohort studies or case series, sporadic cases of nephrotic syndrome associated with malignant mesothelioma have been reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. While most cases are assumed to represent nephrotic syndrome secondary to cancer, nephrotic syndrome may develop during the treatment of mesothelioma, and a mechanism specifically related to chemotherapy has also been postulated [15]. ...
... However, we discuss here the causal relationship between the three events based on the literature as much as possible. We reviewed 15 publications presenting cases of nephrotic syndrome with malignant mesothelioma at various sites [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Seven cases included information on complement levels, all of which were within the normal range. ...
Concomitant Nephrotic Syndrome and Cryoglobulinemia in a Case of Malignant Mesothelioma
Article
Full-text available
  • Sep 2022
Malignant pleural mesothelioma is rarely associated with nephrotic syndrome. Cryoglobulinemia is found in various pathological statuses, such as hepatitis C virus infection but rarely in malignant neoplasms. We recently encountered a patient with malignant mesothelioma coincident with nephrotic syndrome and cryoglobulinemia in the course of chemotherapy. A 60-year-old man employed as a building painter was diagnosed with malignant mesothelioma by lung biopsy two years earlier and was started on chemotherapy. Nivolumab seemed effective in controlling mesothelioma, but skin immune-related adverse events occurred during the course of treatment. After discontinuation of nivolumab and administration of gemcitabine as an alternative therapy, the patient was referred to a nephrologist because of the subsequent development of edema, renal injury, and proteinuria. Following the investigation, he was diagnosed with nephrotic syndrome and cryoglobulinemia with C4-dominant cold activation. However, a percutaneous renal biopsy could not be performed due to persistent severe cough induced by pleural involvement. The patient died a little over three years after the pathological diagnosis of pleural mesothelioma. Our case had three key features nephrotic syndrome was possibly associated with malignant mesothelioma; cryoglobulinemia occurred in malignant mesothelioma; and concomitant nephrotic syndrome and cryoglobulinemia occurred after chemotherapy. Unfortunately, our rare case lacks a basis in renal pathology or evidence of links between the pathogenesis of malignant mesothelioma, cryoglobulinemia, and nephrotic syndrome. This case does not provide a causal mechanism, but may be worth adding to the case list as one of the rare renal involvement in a patient with malignant mesothelioma.
View
... Glomerular disease in the setting of malignancy has been recognized for several decades. Most commonly, the glomerular pathology is membranous nephropathy (Da'as, 2001;Farmer, 2001). Renal lesions in the context of MPM are extremely unusual (Venzano, 1990;Tanaka, 1994;Galesic, 2000;Farmer, 2001;Bacchetta, 2009;Suzuki, 2014;Li, 2010;Dogan, 2012;Tsukamoto, 2015;Yildiz, 2016;Shibata, 2020;Xinyu, 2016;Fawole, 2012) with only 12 cases having been reported in the English-language literature ( Table 1). ...
... Most commonly, the glomerular pathology is membranous nephropathy (Da'as, 2001;Farmer, 2001). Renal lesions in the context of MPM are extremely unusual (Venzano, 1990;Tanaka, 1994;Galesic, 2000;Farmer, 2001;Bacchetta, 2009;Suzuki, 2014;Li, 2010;Dogan, 2012;Tsukamoto, 2015;Yildiz, 2016;Shibata, 2020;Xinyu, 2016;Fawole, 2012) with only 12 cases having been reported in the English-language literature ( Table 1). Six of the reported cases presented MCD, three with membranous nephropathy, one with proliferative segmental GN and one AA amyloidosis. ...
Minimal Change Disease Associated with Malignant Epithelioid Mesothelioma: A Case Report
Article
Full-text available
  • Apr 2021
We report the case of a 64 year old male patient with a recent diagnose of pulmonary nodules with pleural thickening who was admitted to the nephrology department of our hospital for further evaluation of nephrotic syndrome (NS). Malignant epithelioid mesothelioma (MEM) was diagnosed after pleural biopsy while the renal biopsy showed minimal change disease (MCD) with acute tubular necrosis and interstitial lymphoplasmacytic infiltrate. MCD is the most common cause of nephrotic syndrome in children while it accounts for a smaller proportion of NS in adults. The underlying cause of MCD is unclear (Cameron, 1987). Evidence so far suggests that T-cell dysfunction results in the production of a circulating factor directly affecting the glomerular capillary wall with consequent foot process fusion. MCD as paraneoplastic syndrome is common in hematological disorder while the incidence in lung pulmonary malignancies is rare. Early recognition leads to an early diagnosis of malignancy improving the outcome and diminishing the associated co-morbidities.
View
... Patients who developed nephrotic syndrome associated with asbestos-related pulmonary diseases are rare, but eight previous cases have been reported in the English-language literature. Table 2 shows cases of patients with asbestosrelated diseases who developed nephrotic syndrome [10][11][12][13][14][15][16][17]. Most patients had epithelioid mesothelioma, and minimal change disease (MCD) is a common renal pathology. ...
Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases
Article
  • Jun 2020
Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.
View
... In the context of pleural mesothelioma, the association with renal glomerular disease has been rarely reported. There are only 10 cases of nephrotic syndrome associated with mesothelioma in the literature to date (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). These have been previously described, compared, and presented in tabular form, and have been associated with poor survival (3). ...
View
... However, malignant mesothelioma and nephrotic syndrome have been less extensively investigated. A total of 7 cases of nephrotic syndrome associated with malignant mesothelioma have been reported in the English literature (3)(4)(5)(6)(7)(8)(9); the details of these 7 cases are listed in Table I. ...
Membranous nephropathy associated with malignant pleural mesothelioma in an adult patient: A case report
Article
  • Aug 2016
A 23-year-old man presented to our hospital with membranous nephropathy and received a detailed examination, including pleural biopsy, due to a feeling of chest oppression. The result of the pleural biopsy was malignant pleural mesothelioma. However, the patient did not have a history of asbestos or tobacco exposure. A review of the English literature identified only 7 reported cases of concomitant malignant mesothelioma and nephrotic syndrome. Furthermore, among the 7 cases reviewed, 6 had a history of asbestos exposure, 1 had a history of prolonged tobacco exposure and in only 1 case the renal pathology results revealed the presence of membranous nephropathy.
View
Minimal change disease associated with malignant pleural mesothelioma: Case report and review of the literature
Article
Full-text available
  • Dec 2016
A 77-year-old man with a history of asbestosis exposure was admitted to our internal medicine division for generalized weakness, fatigue, loss of weight, night sweats and difficulty for breathing since 3 months. Clinical examination revealed left fine crackles and bilateral leg edema. Blood test showed elevated CRP level at 142 mg/L, lactate dehydrogenase level at 421 UI, creatinine level at 5.75 mg/dl. Serum albumin level at 30 g/L, urinalysis showed significant proteinuria at 6.4 g/L. Chest X-ray showed left pleural effusion. Renal ultrasonography was normal. Thoracic computed tomography and positron emission tomography showed mediastinal enlargement with lymphadenopathies and left pleural effusion and thickening. A pleural biopsy showed features compatible with malignant epithelioid mesothelioma. Renal biopsy showed minimal change disease and acute tubular necrosis. A diagnosis of malignant mesothelioma associated with minimal change disease and acute tubular necrosis secondary was then made. Given the poor general condition, palliative care was initiated and the patient died from respiratory failure 3 months later.
View
Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case
Article
  • Sep 2015
Malignant pleural mesothelioma (MPM) is the aggressive disease typically spreading along the pleural surface and encasing the lung, leading to respiratory failure or cachexia. Rare cases with atypical clinical manifestation or presentation have been reported in MPM. We experienced a unique case of MPM concurrently associated with miliary pulmonary metastases and nephrotic syndrome. A 73-year-old Japanese man with past history of asbestos exposure was referred to our hospital for the investigation of the left pleural effusion. Chest computed tomography showed thickening of the left parietal pleura. Biopsy specimen of the pleura showed proliferating epithelioid tumor cells, leading to the pathological diagnosis of epithelioid MPM with the aid of immunohistochemistry. After the diagnosis of MPM, chemotherapy was performed without effect. Soon after the clinical diagnosis of progressive disease with skull metastasis, edema and weight gain appeared. Laboratory data met the criteria of nephrotic syndrome, and renal biopsy with electron microscopic examination revealed the minimal change disease. Steroid therapy was started but showed no effect. Around the same time of onset of nephrotic syndrome, multiple miliary lung nodules appeared on chest CT. Transbronchial biopsy specimen of the nodules showed the metastatic MPM in the lung. The patient died because of the worsening of the general condition. To our knowledge, this is the first case of MPM concurrently associated with multiple miliary pulmonary metastases and nephrotic syndrome.
View
Minimal Change Disease as a Paraneoplastic Manifestation of Solid Malignant Tumors
Article
Full-text available
  • Jan 2012
Solid malignant tumors are associated with a wide range of paraneoplastic manifestations including glomerular diseases. Membranous nephropathy is commonly associated with solid malignancies but minimal change disease (MCD) has predominantly been reported in association with Hodgkin's lymphoma. The association between MCD and solid malignant tumors has not previously been well described. All case reports and series in the English medical literature of patients with MCD and solid malignant tumors, including malignant thymoma, were systematically reviewed. Thirty-one patients with non-thymoma solid malignant tumors and 26 patients with malignant thymoma associated with MCD were identified. Nephrotic syndrome was present in 91% (52 of 57) of cases. Among those with malignant thymoma and MCD, 16 of 25 (64%) patients whose renal function were reported had impaired renal function, defined as serum creatinine over 120 mmol/L, at the time of presentation. In the solid malignancy group, 15 of 25 (60%) had renal impairment. In the malignant thymoma group, complete, partial or no remission of MCD was observed in 11, 5 and 8 cases, respectively, within the follow-up interval of each report. In the non-thymoma group, 12 of 31 went into complete remission and 10 were in partial remission. Nine cases showed no response to the treatment. There is an association between the activity of MCD and the malignancy status. Death was reported in 15 of 23 patients with solid non-thymo-ma malignancies and 6 of 13 with malignant thymoma. MCD is associated with solid malignant tumors infrequently as a paraneoplastic manifestation. The response of MCD to treatment and survival of this group of patients can be variable depending on the disease stage of the associated malignancy.
View
View
Nephrotic syndrome, renal failure, and renal malignancy: an unusual tumor-associated glomerulonephritis
Article
Full-text available
  • Jun 1997
The association between malignancy and glomerular disease has been appreciated for over three decades. Although the relationship between membranous glomerulonephritis or minimal-change nephrotic syndrome and carcinoma or lymphoma, respectively, are the most widely known, several other glomerular lesions have been described in patients with malignancy. In this article, a patient who presented with nephrotic syndrome, volume overload, and renal failure, who was subsequently found to have a renal mass, is described. Resection of the mass, which proved to be a renal cell carcinoma, led to resolution of proteinuria and improvement of renal function. Pathology on the noninvolved portion of the kidney revealed a membranoproliferative glomerular lesion, a lesion usually associated with lymphomas and not previously described with renal carcinoma. Although a role of tumor antigens and anti-tumor antibodies in producing glomerular immune deposits has been speculated upon, the evidence for this assertion was spotty. However, reports of remission of proteinuria after tumor treatment or removal support a role of tumor products in pathogenesis. Although the association between proteinuria and malignancy is rare, it should be kept in mind, particularly in older patients with membranous glomerulonephritis where the possibility of malignancy needs to be further evaluated.
View
View
View
Nephrotic syndrome associated with pleural mesothelioma. An unusual paraneoplastic event
Article
  • Jun 1990
  • Recenti Prog Med
A case of association between nephrotic syndrome (membranous glomerulopathy) and pleural mesothelioma is presented. It is suggested that this association is a true paraneoplastic syndrome.
View
Minimal-Change Nephrotic Syndrome Associated With Malignant Mesothelioma
Article
  • Oct 1986
  • ARCH INTERN MED
A 68-year-old man presented with nephrotic syndrome. Renal biopsy revealed minimal-change glomerular disease. The proteinuria did not respond to treatment with prednisone and cyclophosphamide. On further workup, the patient was found to have a malignant mesothelioma of the pleura. The proteinuria then improved during treatment with doxorubicin hydrochloride and dacarbazine, without noticeable improvement in the tumor. This case suggests an association between mesothelioma and minimal-change glomerular disease with nephrotic syndrome, previously unreported to our knowledge. Our review revealed only ten previous cases of minimal-change glomerular disease associated with carcinoma.
View
Cholesterol Embolization to the Cecum With Bowel Infarction
Article
  • Feb 1973
  • ARCH SURG-CHICAGO
Cecal gangrene due to sequential cholesterol emboli occurred. The patient described demonstrated several other reported clinical manifestations of cholesterol embolization, ie, hypertension, renal failure, and gastrointestinal hemorrhage. An isolated occurrence of cholesterol embolization may pathologically result in congestion of villi, mucosal petechiae or infarcts, minute hemorrhage and hemorrhagic erosions within the gastrointestinal tract. However, the sequential occurrence of emboli over a prolonged period of time can eventually compromise the circulation to a segment of the gastrointestinal tract causing ischemic necrosis.
View
Lipoprotein(a) Levels and Fibrinolytic Activity in Patients with Nephrotic Syndrome
Article
  • Jan 1995
Recently there has been a renewed interest in the possibility that lipoprotein(a)--Lp(a)--may be important in the pathogenesis of thrombosis-related disease. In nephrotic syndrome, hyperlipidemia is a common finding, and thrombosis is a major complication. With this regard, if Lp(a) levels increase concomitantly with low-density lipoprotein and/or very-low-density lipoprotein levels in nephrotic syndrome, this may be considered a thrombogenic factor. To probe this possibility and to corroborate the relationship between Lp(a) and fibrinolytic profiles, we measured the Lp(a) levels in patients with nephrotic syndrome (n = 43), in patients with chronic glomerulonephritis with less proteinuria than in nephrotic syndrome (n = 28), and in healthy controls (n = 50) and observed the relation between Lp(a) levels and tissue-type plasminogen activator (t-PA) activity, euglobulin fibrinolytic activity, and t-PA antigen. The Lp(a) levels were significantly higher in the patients with nephrotic syndrome as compared with both patients with chronic glomerulonephritis and healthy controls (p < 0.001). There was a direct correlation with serum cholesterol level (r = 0.780; p = 0.0001), triglyceride level (r = 0.445; p = 0.0001), and urine protein level (r = 0.675; p = 0.0001) and a reverse correlation with serum albumin levels (r = 0.566; p = 0.0001). The Lp(a) levels showed a reverse correlation with t-pA activity (r = 0.627; p = 0.0001), total fibrinolytic activity in euglobulin fraction (r = 0.458; p = 0.0001), and t-PA activity divided by the t-PA antigen (r = 0.567; p = 0.0001), but no correlation with t-PA antigen.(ABSTRACT TRUNCATED AT 250 WORDS)
View
View
Spontaneous Arterial Thrombosis Associated with Nephrotic Syndrome: Case Report and Review of the Literature
Article
  • Feb 1995
Hypercoagulability is a recognized complication of the nephrotic syndrome which commonly affects the venous system. Arterial thrombosis is very rare. Multiple factors contribute to the predisposition to thromboembolism in this condition. This report deals with a case of femoral artery thrombosis which responded well to thrombectomy and a short course of anticoagulant therapy. In spite of several exacerbations of his disease, our patients had no recurrence of thrombosis. Review of the literature reveals high rates of limb loss and recurrence of thrombosis. We, therefore, feel that it is important to emphasize this rare entity in view of the associated morbidity.
View
Brain Metastasis in Malignant Pleural Mesothelioma
Article
  • Sep 1997
A 55-year-old male who had a remote history of occupational asbestos exposure consulted us because of chest pain. Chest X-ray revealed diffuse pleural thickening and pleural effusion on the right. A diagnosis of malignant mesothelioma, biphasic type was made by needle pleural biopsy. Fourteen months later, the patient died of brain metastasis. At autopsy, malignant mesothelioma of the pleura with metastasis to the brain and bilateral adrenal glands was observed. Brain metastases proven by autopsy are rare in cases of malignant mesothelioma. The ferruginous body count in the lung tissue was 16 per gram of wet weight. (Internal Medicine 36: 591-594, 1997)
View