IL-6-producing Renal Cell Carcinoma Causing Renal and Endocrine Paraneoplastic Syndromes

Abstract

An 83-year-old man with stable chronic kidney disease (CKD) exhibited a sudden increase in urinary N-acetyl-β-D-glucosaminidase and protein excretion, suggesting aggravated kidney damage. Simultaneously, he lost diabetic control, requiring up to 54 units of insulin daily. A detailed examination revealed the presence of renal cell carcinoma, which was surgically resected and confirmed to be interleukin-6-positive by immunohistochemistry. Postoperatively, his uni-nephrectomy necessitated hemodialysis, but the patient’s insulin resistance was ameliorated; no medication was required to control diabetes, suggesting that the tumor had caused the insulin resistance. This report describes a case of a tumor secreting interleukin-6, which affects both the control of diabetes and CKD progression.

Case Report: Hematologic Recovery Following Stereotactic Ablative Radiotherapy in a Patient With Early-Stage Non-Small Cell Lung Cancer and Paraneoplastic Myelofibrosis

“…Primary myelofibrosis has been associated with excess circulating serum cytokines including, IL-6 ( 11 ), which is also highly expressed by NSCLC tumor cells ( 12 ). IL-6 has been reported to be involved in the pathophysiology of multiple paraneoplastic syndromes, including the aforementioned leukemoid reactions ( 29 – 31 ). As cytokines have been reported to be responsible for some paraneoplastic hematopoietic syndromes in patients with NSCLC, as described above ( 32 ), we propose that one potential mechanism to explain these findings could involve systemic IL-6 levels.…”

Renal Cell Carcinoma–Associated Diabetes Mellitus Due to Paraneoplastic Syndrome in Maintenance Hemodialysis: A Case Report

“…Spyridopoulos et al 2 examined the association of RCC with diabetes and insulin resistance as assessed by HOMA-IR; RCC was positively correlated with the development of diabetes mellitus but negatively correlated with insulin resistance. Okada et al 3 reported on an 83-year-old man with stable chronic kidney disease who exhibited a sudden increase in urinary protein excretion and poor glycemic control. The patient was diagnosed with RCC, and glycemic control improved after nephrectomy; immunohistochemistry confirmed that the RCC tissue was positive for interleukin-6 (IL-6).…”

“…They suggested that the production of IL-6 in RCC may be related to the development of diabetes via insulin resistance, but the positivity of staining usually confirms only the overproduction of IL-6 and does not necessarily indicate elevated levels of serum IL-6. 3 Blay et al 4 reported that IL-6 associated with RCC was related to elevation of C-reactive protein, haptoglobin, thrombocytosis, neutrophilia, and monocytosis but did not mention abnormalities in blood glucose. Elias 5 reported on a 52-year-old woman with new-onset diabetes.…”

“…Because some reports suggested a relationship between IL-6 and RCC, 3 , 10 serum IL-6 levels were determined using stored sera at 3 points, 1 year before RCC diagnosis, at the time of RCC diagnosis, and 1 year after surgery, with measurements of 18.4 pg/mL, 189 pg/mL, and <7.0 pg/mL, respectively. There seemed to be a relationship between RCC and IL-6.…”

Unusual Neurologic Paraneoplastic Syndrome in a Patient with Clear Cell Renal Cell Carcinoma

“…Renal cell carcinoma is the sixth most commonly diagnosed cancer in men and the tenth most commonly diagnosed cancer in women, representing 5% and 3% of all cancers, respectively 1 Paraneoplastic syndromes arise from tumor secretion of hormones, peptides, or cytokines or from immune cross-reactivity between malignant and nonmalignant tissue that can affect multiple organs 2 Common paraneoplastic syndromes resulting from renal cell carcinoma include hypercalcemia, Stauffer's syndrome, hypertension, and persistent leukocytosis. 3 There are rare case reports of paraneoplastic syndromes secondary to renal cell carcinoma with neurologic presentations including opsoclonus-myoclonus, frontal lobe disorders, cerebellar degeneration, bilateral phrenic nerve paralysis, and amyotrophic lateral sclerosis, and motor weakness associated with sensory deficits.…”