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Membranous nephropathy, leiomyoma and autoimmune myasthenia: more than a coincidence?

Calviño J, Adeva M, Sobrido MJ - Clin Kidney J (2012)

Bottom Line: Membranous nephropathy (MN) has been associated with several infectious, immunological and malignant conditions, but had only rarely been reported with malignant and other immune disorders in the same patient.Thus, we report here for the first time the coincidence of these conditions in the same patient.The possible basis for the relationship between these diseases is discussed, and some common genetic and immune physiopathological pathways are hypothesized.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Hospital Lucus Augusti , Lugo , Spain.

ABSTRACT
Membranous nephropathy (MN) has been associated with several infectious, immunological and malignant conditions, but had only rarely been reported with malignant and other immune disorders in the same patient. We describe the case of a 56-year-old male with MN who was also diagnosed with a gastrointestinal stromal tumour (GIST), myasthenia gravis (MG) and thymic hyperplasia. Thus, we report here for the first time the coincidence of these conditions in the same patient. There was a recurrence of nephrotic syndrome without impairment of renal function 5 years after removal of the GIST (3 years after thymectomy). The possible basis for the relationship between these diseases is discussed, and some common genetic and immune physiopathological pathways are hypothesized.

No MeSH data available.


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Patient's renal function outcome.
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SFS144F1: Patient's renal function outcome.

Mentions: Symptomatic and anti-proteinuric treatments, including furosemide, enalapril, statin and aspirin, were initially prescribed, leading to symptomatic improvement but renal function parameters worsened [serum creatinine 123 µmol/L (1.4 mg/dL), proteinuria 10 g/24 h]. Enalapril was increased to the maximum tolerated dose (up to 40 mg/day), without benefit. Then Ponticelli's [1] therapy regimen, including steroids and chlorambucil, was started. One month later (at the end of the first course of steroids and before starting chlorambucil), the patient was admitted for gastrointestinal bleeding and worsening of renal function [serum creatinine 158 µmol/L (1.8 mg/dL)]. An endoscopy showed a large leiomyomatous mass with central ulceration in the posterior gastric wall. A partial gastrectomy with complete tumour removal was carried out after clinical stabilization. The histological study revealed features of a gastric stromal tumour. The patient did not receive complementary chemotherapy. After surgery, proteinuria decreased (down to 2.3 g/24 h) and the renal function normalized [serum creatinine 88 µmol/L (1.0 mg/dL)]. Three months after discharge (Figure 1), the nephropathy was in complete remission and the patient was only on a low dose of enalapril (5 mg/day).Fig. 1


Membranous nephropathy, leiomyoma and autoimmune myasthenia: more than a coincidence?

Calviño J, Adeva M, Sobrido MJ - Clin Kidney J (2012)

Patient's renal function outcome.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400566&req=5

SFS144F1: Patient's renal function outcome.
Mentions: Symptomatic and anti-proteinuric treatments, including furosemide, enalapril, statin and aspirin, were initially prescribed, leading to symptomatic improvement but renal function parameters worsened [serum creatinine 123 µmol/L (1.4 mg/dL), proteinuria 10 g/24 h]. Enalapril was increased to the maximum tolerated dose (up to 40 mg/day), without benefit. Then Ponticelli's [1] therapy regimen, including steroids and chlorambucil, was started. One month later (at the end of the first course of steroids and before starting chlorambucil), the patient was admitted for gastrointestinal bleeding and worsening of renal function [serum creatinine 158 µmol/L (1.8 mg/dL)]. An endoscopy showed a large leiomyomatous mass with central ulceration in the posterior gastric wall. A partial gastrectomy with complete tumour removal was carried out after clinical stabilization. The histological study revealed features of a gastric stromal tumour. The patient did not receive complementary chemotherapy. After surgery, proteinuria decreased (down to 2.3 g/24 h) and the renal function normalized [serum creatinine 88 µmol/L (1.0 mg/dL)]. Three months after discharge (Figure 1), the nephropathy was in complete remission and the patient was only on a low dose of enalapril (5 mg/day).Fig. 1

Bottom Line: Membranous nephropathy (MN) has been associated with several infectious, immunological and malignant conditions, but had only rarely been reported with malignant and other immune disorders in the same patient.Thus, we report here for the first time the coincidence of these conditions in the same patient.The possible basis for the relationship between these diseases is discussed, and some common genetic and immune physiopathological pathways are hypothesized.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Hospital Lucus Augusti , Lugo , Spain.

ABSTRACT
Membranous nephropathy (MN) has been associated with several infectious, immunological and malignant conditions, but had only rarely been reported with malignant and other immune disorders in the same patient. We describe the case of a 56-year-old male with MN who was also diagnosed with a gastrointestinal stromal tumour (GIST), myasthenia gravis (MG) and thymic hyperplasia. Thus, we report here for the first time the coincidence of these conditions in the same patient. There was a recurrence of nephrotic syndrome without impairment of renal function 5 years after removal of the GIST (3 years after thymectomy). The possible basis for the relationship between these diseases is discussed, and some common genetic and immune physiopathological pathways are hypothesized.

No MeSH data available.


Related in: MedlinePlus