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Abstract: SA-PO245

A Case of Paraneoplastic ANCA-Associated Glomerulonephritis in a Patient with Non-Small-Cell Lung Carcinoma

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Ismail, Nader, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Henriksen, Kammi J., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Bonilla Arevalo, Marco Antonio, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States

Paraneoplastic glomerular diseases are rare immune-mediated disorders temporally correlated with the detection of an underlying malignancy. The association between malignancies and glomerular diseases has been most commonly described with solid tumors and membranous nephropathy. In contrast, Anti-Neutrophil Cytoplasmic Antibody (ANCA) vasculitis in patients with solid carcinomas is a rare occurrence.

Case Description

A 76-year-old female former smoker with a medical history of Sjogren's syndrome presented to our nephrology clinic to evaluate worsening kidney function. Two months prior, she was diagnosed with metastatic squamous cell carcinoma of the lung and received 1 dose of pembrolizumab 1 week prior to nephrology evaluation. She reported decreased appetite, weight loss, and fatigue. Physical examination was remarkable only for blood pressure of 152/68 mmHg. Laboratory findings showed worsening serum creatinine from a baseline of 1.6 mg/dL (two months prior) to a peak of 4.1mg/dL. Urinalysis showed positive blood with >20 RBCs per HPF and a urine protein and creatinine ratio of 5g/g. Serological workup showed positive anti-SSA, positive anti-MPO, and negative anti-PR-3 titers. She underwent a kidney biopsy which revealed a focal pauci-immune crescentic and sclerosis glomerulonephritis. The decision was to temporarily hold the immunotherapy and to start treatment with corticosteroids and Rituximab. A 2-month clinical follow-up showed a serum creatinine stable to 2.4mg/dL.


In the last decade, there has been increased awareness of the association between malignancies, cancer treatment, and glomerular diseases. A paraneoplastic glomerular disease can be challenging to distinguish from a drug-induced or a primary glomerular disease in the setting of illness and treatment of underlying malignancy. Moreover, it poses an essential dilemma regarding management decisions concerning treatment for underlying cancer versus treating the glomerular disorder if the therapies cannot be given concurrently. In our case, we attributed the AAV to a paraneoplastic glomerular disease; the subacute rise in the creatinine coincided with the newly diagnosed lung cancer. One dose of immune checkpoint inhibitor was less likely the culprit. This case adds to the literature on this rare manifestation of AAV presenting as a paraneoplastic disease.