Abstract: SA-PO1280
A Rare Case of Paraneoplastic Minimal Change Disease in Neuroendocrine Cancer
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Radhakrishna, Roshni, The Nephrology Clinic, Fort Collins, Colorado, United States
- Evans, Jordan R., The Nephrology Clinic, Fort Collins, Colorado, United States
- Teruel, Mark A., The Nephrology Clinic, Fort Collins, Colorado, United States
- Bu, Lihong, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction
Minimal change disease (MCD) is an uncommon cause of nephrotic syndrome in adults. As a paraneoplastic process, it is most frequently associated with hematologic malignancies and less commonly with solid tumors. MCD associated with neuroendocrine tumors (NETs) is exceedingly rare. We present a case of biopsy-confirmed MCD in a patient with metastatic NET who developed nephrotic syndrome and acute kidney injury (AKI).
Case Description
A 69-year-old man with metastatic NET diagnosed in Fall 2025 presented with AKI and nephrotic syndrome. PET scan demonstrated widespread FDG-avid malignancy involving the tongue, lung, lymph nodes, gallbladder, liver, pancreas, peritoneum, prostate, and skeleton. Omental biopsy confirmed a well-differentiated grade 3 NET of unspecified primary origin. Ga-68 DOTATATE PET scan demonstrated extensive somatostatin receptor–positive metastatic disease. He was started on palliative chemotherapy with capecitabine and temozolomide in January 2026, along with zoledronate for osseous metastases. By Spring 2026, he developed worsening edema, hypoalbuminemia, and renal dysfunction requiring hospitalization. UPC ratio exceeded 17 g/g, with 24-hour urine protein >9 g/day. Serum creatinine increased from a baseline of 0.9–1.0 mg/dL to a peak of 3.9 mg/dL. Serologic workup was negative, including ANA, complements, anti-dsDNA, ANCA, anti-PLA2R, anti-GBM, hepatitis B/C, serum FLC ratio, and SPEP/UPEP. Renal biopsy demonstrated acute tubular injury with severe diffuse podocyte foot process effacement and fine granular/dusting staining for IgG consistent with MCD. Renal function continues to worsen, and immunosuppressive therapy is being considered while Oncology evaluates treatment with lanreotide and 177Lu-Dotatate.
Discussion
Paraneoplastic MCD is rarely associated with solid tumors, most commonly thymic and renal. Only a few adult cases associated with NETs have been reported. Proposed mechanisms include tumor-mediated immune dysregulation and cytokine-driven podocyte injury.
Data regarding optimal management and outcomes remain limited. Prior reviews suggest remission may occur with immunosuppressive therapy alone in some patients and with anticancer therapy alone in others. Additional studies are needed to better define the roles of immunosuppressive versus oncologic treatment. Kidney biopsy remains essential for diagnosis, exclusion of alternative renal lesions, and therapeutic decision-making.