Remission of nephrotic syndrome after surgical intervention for bronchogenic carcinoma: the 10-year follow-up of a patient with membranous nephropathy

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.

[1]  E. Knight,et al.  Prevalence of Cancer in Membranous Nephropathy: A Systematic Review and Meta-Analysis of Observational Studies , 2014, American Journal of Nephrology.

[2]  E. Kusano,et al.  Do We Have to Perform a Renal Biopsy? Clinical Dilemmas in a Case with Nephrotic Syndrome , 2014, Clinical medicine insights. Case reports.

[3]  Y. Yamano,et al.  Long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by nephrotic syndrome. , 2014, Internal medicine.

[4]  J. Radhakrishnan,et al.  Glomerular diseases seen with cancer and chemotherapy: a narrative review. , 2013, Kidney international.

[5]  T. Kawano,et al.  A patient with esophageal cancer showing remission of nephrotic syndrome after esophagectomy: report of a case , 2013, Surgery Today.

[6]  S. Muto,et al.  Development of features of glomerulopathy in tumor-bearing rats: a potential model for paraneoplastic glomerulopathy. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[7]  R. Glassock Attending rounds: an older patient with nephrotic syndrome. , 2012, Clinical journal of the American Society of Nephrology : CJASN.

[8]  T. Sugase,et al.  Minimal change nephrotic syndrome complicated with malignant ascites in a patient with type II diabetes. , 2012, Internal medicine.

[9]  D. Salant,et al.  Anti-phospholipase A2 receptor antibody in membranous nephropathy. , 2011, Journal of the American Society of Nephrology : JASN.

[10]  L. Lai,et al.  Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis , 2011, Nature Reviews Nephrology.

[11]  K. Nuorva,et al.  Remission of membranous glomerulonephritis after pancreatectomy for pancreatic neuroendocrine neoplasm - a rare coincidence. , 2011, Clinical nephrology.

[12]  A. Cybulsky Membranous nephropathy. , 2011, Contributions to nephrology.

[13]  T. Sugase,et al.  A case of cervical cancer-related membranous nephropathy treated with radiation therapy. , 2011, Internal medicine.

[14]  克治 桑門 海外論文紹介 : M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy , 2010 .

[15]  J. Bacchetta,et al.  Paraneoplastic glomerular diseases and malignancies. , 2009, Critical reviews in oncology/hematology.

[16]  F. Langmark,et al.  Long-term risk of cancer in membranous nephropathy patients. , 2007, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  B. Stengel,et al.  Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association. , 2006, Kidney international.

[18]  A. Komatsuda,et al.  Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[19]  W. Couser,et al.  Therapy of membranous nephropathy associated with malignancy and secondary causes. , 2003, Seminars in nephrology.

[20]  H. Matsuura,et al.  Nephrotic Syndrome due to Membranous Nephropathy Associated with Metastatic Prostate Cancer: Rapid Remission after Initial Endocrine Therapy , 2000, Nephron.

[21]  H. Makino,et al.  Effectiveness of Radiation Therapy in Nephrotic Syndrome Associated with Advanced Lung Cancer , 1999, Nephron.

[22]  P. Ronco,et al.  Paraneoplastic glomerulopathies: new insights into an old entity. , 1999, Kidney international.

[23]  J. Bone,et al.  Solid tumour and glomerulopathy , 1996 .

[24]  J. V. van Noord,et al.  Small cell lung cancer with paraneoplastic nephrotic syndrome. , 1994, The European respiratory journal.

[25]  M. Schwartz,et al.  Membranous glomerulonephritis and malignancy. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  M. Averbuch,et al.  Nephrotic syndrome complicating adenocarcinoma of the lung with resolution after resection. , 1991, The Annals of thoracic surgery.

[27]  J. Hopper,et al.  Cure of membranous nephropathy after resection of carcinoma. , 1985, Archives of internal medicine.

[28]  S. O’Neill,et al.  Glomerulopathies of neoplasia. , 1981, Irish medical journal.

[29]  E. Cantrell Nephrotic Syndrome Cured by Removal of Gastric Carcinoma , 1969, British medical journal.