Abstract: SA-PO1024

Autoantibodies: Novel Biomarkers for Diagnosing Malignancy?

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Malhotra, Divyanshu, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Gondal, Maryam, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Luciano, Randy L., Yale University School of Medicine, New Haven, Connecticut, United States
Background

ANA and related autoantibodies can be detected with a variable frequency in patients with Lymphoma. However, a majority of these patients do not display features of any underlying autoimmune disease. The exact patho-physiological significance of these is not well defined at this time. Here we present a case of positive autoantibodies in a patient with T-cell Lymphoma and membranous nephropathy which initially posed a diagnostic dilemma.

Methods

37 year old male with an unremarkable past medical history was admitted for fatigue, lethargy, anorexia and weight loss. He had been experiencing shortness of breath with exertion and also noted that his urine was foamy. He was taking naproxen infrequently for generalized pain. Physical exam was remarkable for significant peripheral edema. Labs revealed a BUN 48 mg/dl, Cr 3.2 mg/dl, phosphorus 5.8 mg/dl, Hgb 7.1g/dl, Platelet count 30000, Albumin 2.2 g/dl and Urine Pr/Cr 5 g/g. Urine analysis showed a mix of isomorphic and dysmorphic RBCs however no casts were noted. Autoimmune work up was positive for ANA, AntidsDNA, AntiSm, AntiSm/RNP and Anti SS-B. However he did not meet the criteria for SLE and did not have any clinical features consistent with other autoimmune conditions. Thus a further work up was planned. Renal US was remarkable for echogenic right and left kidney measuring 12.7 cm and 13.8 cm respectively. Renal Biopsy was consistent with membranous nephropathy with negative immunofluorescence. Bone Marrow biopsy was performed and was consistent with T-cell lymphoma and this prompted initiation of chemotherapy. Unfortunately, despite therapy his disease progressed with multi-organ involvement and patient was transitioned to hospice care.

Conclusion

A wide spectrum of renal lesions can be observed in patients with T-Cell Lymphoma including glomerulonephritis, acute kidney injury and parenchymal infiltration. This case is unique, as the autoimmune markers were not related to the glomerulonephritis but independently associated with the T-Cell Lymphoma. In small retrospective analyses it is interesting to note that these autoantibodies were generally not assocaited with underlying auto-immune conditions, were seen more commonly in men and did not appear to have any significant prognositc significance. Thus it is important to recognize this entity and look for underlying malignancies when the clinical features do not corelate.