Membranous nephropathy associated with ovarian tumour in a young girl: recovery after removal

Abstract

We report a 7-year-old girl who presented with membranous glomerulonephritis and steroid-resistant nephrotic syndrome in association with a benign ovarian tumour. Surgical excision of the tumor led to complete disappearance of the proteinuria within 2 weeks. Tumour-associated membranous nephropathy in children is rare, as a review of the literature shows.

Membranous Nephropathy and Granuloma

“…Membranous nephropathy associated with benign tumor have also been reported by several authors [2][3][4], but up to now, we have not found an association between membranous nephropathy and granuloma.…”

Membranoproliferative Glomerulonephritis Associated with a Mixed-Cell Germinal Ovary Tumor

“…The possibility of a fortuitous association must be considered. However, the assumption of a cause-effect link between these two conditions is highly attractive, especially since our patient had improved her nephrotic syndrome after oophorectomy, as occurred in the case reported by Beauvais et al [14], but this patient's tumor was detected too late, and nephrotic syndrome did not revert. In addition, embryonal carcinoma is considered a manifestation of chronic antigenic stimulation due to production of fetal antigens [19]; it is also associated with an altered immune state, exhibiting a strong hyperimmune response to both endogenous or experimentally administered antigens [7].…”

“…On the other hand, only a few cases with ovary tumors associated with nephrotic syndrome have been reported. Reviewing the literature, we have found 5 cases (table 1) with glomerulonephritis and ovary tumors: 2 cases described by Lee et al [1], 2 cases reported by Torres and Donadio [9], and 1 case described by Beauvais et al [14]. MPGN is a morphological entity and is associated with chronic primary, and usually progressive, glomerulonephritis that occurs in older children and adults [9,15].…”

“…Hodgkin's and other lymphomas have been the most frequently reported tumors associated with nephrotic syndrome [5-9], although other malignancies including carcinomas of stomach, colon, and ovary have been reported [1,7,9,13,14]. It is generally considered that solid tumors are associated with membranous nephropathy [1,[4][5][6][7]13].…”

A Case of Cervical Cancer-related Membranous Nephropathy Treated with Radiation Therapy

“…Remission of MN-related nephrotic syndrome by cancer resection (2,3,16,17), chemotherapy (18), or radiation therapy (19) has been reported. In the present case, the extent of urinary protein excretion and edema did not change after the first session of radiation therapy to the pelvis.…”