ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1595

A Rare Case of Paraneoplastic IgA Nephropathy in the Setting of Renal Cell Carcinoma

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tyagi, Alka A., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Doraiswamy, Mohankumar, 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
Introduction

Paraneoplastic nephropathy can present in patients with malignancy. Renal cell carcinoma (RCC) is the most common urologic malignancy; there is a paucity of reported paraneoplastic nephropathies associated with this condition. As such, we present an intriguingly unique case of nephrotic range proteinuria in the setting of recurrent, metastatic renal cell carcinoma.

Case Description

An 81-year-old male with history of recurrent metastatic RCC, solitary kidney after a nephrectomy, with stage III chronic kidney disease (CKD) presents with newly worsening renal function. In a 3-month span, his creatinine (Cr) rose from 1.35 mg/dL up to 4.6 mg/dL, which prompted further evaluation. He had reported taking daily nonsteroidal anti-inflammatory drugs along with his ACE-inhibitor. Urinalysis showed microscopic hematuria with random urine protein/creatinine ratio resulted 16 g/g and renal ultrasound was unrevealing. Other serologic tests at the time were notable for C3 134 mg/dL, C4 32 mg/dL, negative ANA, negative C-ANCA. Of note, he had suffered an E. coli and MRSA UTI, clostridium difficile infection, and was treated for pneumonia with anti-microbials. A renal biopsy was obtained with pathology significant for IgA-dominant mesangial and capillary wall immune complex deposition with only segmental and weak C3 (Oxford score was reported as M1, E1, S1, T0, C0). Because of the weak C3, in spite of the patient's history of recent infections, a secondary para-neoplastic IgA nephropathy was favored. He was treated with Nivolumab plus Ipilimumab with improvement in serum Cr improved to 2.23 mg/dL in the following 3 months after starting immunotherapy and remained stable in one-year follow up.

Discussion

Acutely worsening renal function and nephrotic range proteinuria in the setting of malignancy prompts investigation into a paraneoplastic nephropathy. As in this case, secondary IgA mesangial nephropathy can rarely present with RCC. This association is scarce and furthermore there is a lack of understanding of the development of this glomerulopathy. Treatment of the underlying malignancy has shown to improve and preserve renal function. Further investigation into the immune-pathophysiology can help drive the development of further treatment strategies.