Recurrent membranous nephropathy with a possible alteration in the etiology: a case report
| Autor: | Hitoshi Mizuno, Takashi Oki, Tadashi Hanai, Keiko Kojima, Isao Matsui, Yoshitaka Isaka, Kazunori Inoue, Keiji Mano, Karin Shimada, Yusuke Katsuma, Ayumi Matsumoto, Tetsuya Kaneko, Seiichi Yasuda |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Nephrology Male medicine.medical_specialty Membranous nephropathy Biopsy Case Report 030204 cardiovascular system & hematology Malignancy Gastroenterology Glomerulonephritis Membranous 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Recurrence Internal medicine medicine Humans Aged Autoantibodies Cancer Urinary bladder Bladder cancer medicine.diagnostic_test business.industry Receptors Phospholipase A2 medicine.disease Immunohistochemistry Diseases of the genitourinary system. Urology 030104 developmental biology medicine.anatomical_structure Urinary Bladder Neoplasms Thrombospondin type-1 domain-containing 7A RC870-923 Renal biopsy business Thrombospondins Nephrotic syndrome |
| Zdroj: | BMC Nephrology BMC Nephrology, Vol 22, Iss 1, Pp 1-5 (2021) |
| ISSN: | 1471-2369 |
| Popis: | Background Phospholipase A2 receptor 1 (PLA2R1) and thrombospondin type-1 domain-containing 7A (THSD7A) are the two major pathogenic antigens for membranous nephropathy (MN). It has been reported that THSD7A-associated MN has a higher prevalence of comorbid malignancy than PLA2R1-associated MN. Here we present a case of MN whose etiology might change from idiopathic to malignancy-associated MN during the patient’s clinical course. Case presentation A 68-year-old man with nephrotic syndrome was diagnosed with MN by renal biopsy. Immunohistochemistry showed that the kidney specimen was negative for THSD7A. The first course of corticosteroid therapy achieved partial remission; however, nephrotic syndrome recurred 1 year later. Two years later, his abdominal echography revealed a urinary bladder tumor, but he did not wish to undergo additional diagnostic examinations. Because his proteinuria increased consecutively, corticosteroid therapy was resumed, but it failed to achieve remission. Another kidney biopsy was performed and revealed MN with positive staining for THSD7A. PLA2R1 staining levels were negative for both first and second biopsies. Because his bladder tumor had gradually enlarged, he agreed to undergo bladder tumor resection. Pathological examination indicated that the tumor was THDS7A-positive bladder cancer. Subsequently, his proteinuria decreased and remained in remission. Conclusions This case suggests that the etiology of MN might be altered during the therapeutic course. Intensive screening for malignancy may be preferable in patients with unexpected recurrence of proteinuria and/or change in therapy response. |
| Databáze: | OpenAIRE |
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