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Kidney Week

Abstract: PO2218

Paraneoplastic Minimal Change Disease Associated with High-Grade Neuroendocrine Tumor

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

  • Doraiswamy, Mohankumar, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Carter, Jessamyn S., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Madhavan, Sethu M., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Prosek, Jason, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Introduction

Minimal Change Disease (MCD) is usually associated with Lymphoma, Leukemia and solid tumors like Lung Cancer, Renal Cell Carcinoma and Thymoma but data on incidence of paraneoplastic glomerular disease are lacking. To our knowledge, only two cases of neuroendocrine tumor (NET) presenting with Paraneoplastic MCD reported in literature. We present a 47 year-old man with duodenal NET presented with nephrotic syndrome and renal biopsy was suggestive of minimal change disease.

Case Description

A 47 year-old-man with history of well-differentiated metastatic NET (not on therapy) and HTN admitted for dyspnea and anasarca for two weeks. His labs were significant for creatinine of 3.9 mg/dL, albumin 1.9 g/dL, proteinuria of 4.3 g/day and Na 118 mmol/L. IV diuretics with albumin infusion initiated, which improved his kidney function. Serologies and proteinuria workup - negative. Renal biopsy performed for nephrotic syndrome, showed prominent podocyte foot process effacement with mild acute tubular necrosis and mild glomerular sclerosis. Diagnosed with paraneoplastic MCD from metastatic NET and treatment with steroids initiated. Chemotherapy not started because of the overall decline in his clinical status and increased tumor burden. One week after steroids, his proteinuria was 42 g/day, and steroid doses were increased. Three weeks later, proteinuria decreased to 6 g/day and his symptoms improving. Unfortunately, he suffered further kidney injury because of hypotension and hemodialysis initiated one month later.

Discussion

The most common paraneoplastic glomerular disease is membranous glomerulopathy in tumors, but MCD should be kept on the differential as well. Like membranous nephropathy, remission of MCD been reported on ablation of the tumor, suggesting a paraneoplastic process, though the precise mechanisms are not fully understood. In our case, since the patient did not qualify for chemotherapy because of increased tumor burden, steroids were initiated which helped in part to reduce symptoms. The etiology of glomerulopathy in cancer does not appear to be related to tumor burden, metastatic spread or the site or extent of invasion, but to the secretion of substances from the tumor cells. Kidney biopsy should be performed early, as prompt diagnosis is important to ensure patients do not receive ineffective and potentially harmful treatments.