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Abstract: PO2206

Breast Cancer-Associated Podocytopathy

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Muzib, Abdulrahman, Northwell Health, Great Neck, New York, United States
  • Wanchoo, Rimda, Northwell Health, Great Neck, New York, United States
  • Jhaveri, Kenar D., Northwell Health, Great Neck, New York, United States
Introduction

Podocytopathies such as FSGS have not been classically associated with solid malignancy. Here we present a case of a female with a diagnosis of FSGS and its association bilateral lobular carcinoma in situ of the breast.

Case Description

A 52 year old Sri Lankan female with history of DM2( with no prior proteinuria) was referred for sudden onset of proteinuria. The patient first reported profound foamy urine in October 2017 with workup significant for sub-nephrotic proteinuria of 2 gram with normal serum creatinine and albumin. A kidney sonogram unremarkable. Further workup was negative for infectious, autoimmune, vasculitis and para-protein etiologies. The patient was started on Lisinopril 10mg, however proteinuria worsened to 12.6 grams thereby switch to losartan (100mg daily) with slight improvement in proteinuria. A kidney biopsy was performed which showed focal global glomerulosclerosis secondary to adaptive changes with minimal fibrosis with no diabetic nephropathy related changes seen. Light microscopy showed globally sclerosis (9%) and IFTA (5-10%). Immunofluorescence microscopy showed no evidence of primary podocyte disease, immune complex-mediated disease or para-protein deposition disease.
The patient was managed conservatively on anti-proteinuric agent. Almost a year after the diagnosis of FSGS, patient was diagnosed with bilateral lobular carcinoma in situ (breast) with atypical lobular hyperplasia. She underwent lobectomy and started on anastrozole. Following cancer surgery and initiation of hormonal therapy, she noticed resolution of her fatigue, urine foamy and proteinuria (repeat UP/Cr <23 mg (Figure 1)).

Discussion

Our case demonstrates a potential link of the diagnosis of lobular ductal cancer of the breast with a diagnosis of FSGS. Interestingly, the FSGS diagnosis preceded the diagnosis of the breast cancer. While the proteinuria came into partial remission with conservative management, a dramatic resolution of FSGS was noted post-surgery and hormonal therapy for the breast cancer.