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      Recurrence of Paraneoplastic Membranous Glomerulonephritis Following Chemoradiation in a Man With Non-Small-Cell Lung Carcinoma

      case-report

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          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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          Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association.

          C Lefaucheur, C Jacquot, J Rossert … (2006)
          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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            Paraneoplastic glomerulopathies: new insights into an old entity.

            P Ronco (1999)
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              Glomerulopathies of neoplasia.

              J Eagen (1977)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rare Tumors
                Journal ID (iso-abbrev): Rare Tumors
                Journal ID (publisher-id): RT
                Title: Rare Tumors
                Publisher: PAGEPress Publications
                ISSN (Print): 2036-3605
                ISSN (Electronic): 2036-3613
                Publication date (Electronic): 06 May 2013
                Publication date Collection: 15 April 2013
                Volume: 5
                Issue: 2
                Pages: 62-64
                Affiliations
                Departments of [1 ] Radiation Oncology
                [2 ]Nephrology
                [3 ]Hematology/Oncology, Alpert Medical School of Brown University , Providence, RI, USA
                Author notes
                Alpert Medical School of Brown University, Department of Radiation Oncology, Rhode Island Hospital, 593 Eddy Street Providence, RI 02903, USA. E-mail: jhepel@ 123456lifespan.org
                Contributions: ARC wrote the manuscript and made substantial contributions to the conception and design of this report and to data analysis. LD, KL, and HK provided data analysis and provided critical review of the manuscript for important intellectual content. JTH assisted with writing the manuscript and made substantial contributions to the conception and design of this report and to data analysis.
                Conflict of interests: the authors declare no potential conflict of interests.
                This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BYNC 3.0).
                Article
                DOI: 10.4081/rt.2013.e16
                PMC ID: 3719111
                PubMed ID: 23888216
                SO-VID: adea0472-66a0-4cd8-8cfc-9d68a4634eef
                Copyright © ©Copyright A.R. Crawford et al.,
                History
                Date received : 14 October 2012
                Date accepted : 16 January 2013
                Date revision received : 19 December 2012
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 18, Pages: 3
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: paraneoplastic syndrome,nephrotic syndrome
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: paraneoplastic syndrome, nephrotic syndrome

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