Minimal Change Nephrotic Syndrome Complicated with Malignant Ascites in a Patient with Type II Diabetes

Abstract

A large number of renal biopsy studies have shown the concurrent presence of non-diabetic renal disease in diabetics. This report describes one such diabetic female patient with nephrotic syndrome due to minimal change glomerular disease who was successfully treated with prednisolone. Despite the remission of her nephrotic syndrome, she had gradual development of malignant ascites, which was finally interpreted to be linked to primary peritoneal carcinoma. It is necessary to bear in mind that malignancies may not only be the underlying etiology for paraneoplastic glomerular injuries, but also can be an independent pathogenic process, regardless of their nephrotic status during the overall management of the patients with ascites.

Remission of nephrotic syndrome after surgical intervention for bronchogenic carcinoma: the 10-year follow-up of a patient with membranous nephropathy

“…As sex-specific surveys, the measurement of the prostate-specific antigen level, a careful breast examination, a mammogram, and cervical cytology should be performed, while further investigations, including bronchoscopy, gastroscopy, and CT, may be in order after the first-line assessment 9,12,14. Some of these investigations are practiced empirically in the ordinary clinical settings; however, the extent of the workup would vary depending on the context 1,15,16. Otherwise, we may need to focus on the recent landmark studies demonstrating the diagnostic impact of anti-phospholipase A2-receptor (anti-PLA2) autoantibodies, which have received focus as a pathognomonic indicator of idiopathic MN,17,18 although these can occasionally be seen in patients with other glomerular diseases as well 18,19.…”

CA 125 Elevation Due to Minimal Change Disease

“…Tümör markerlarının tek başlarına tanısal değerleri düşük olmakla birlikte olgumuzda olduğu gibi 30 kat kadar oldukça yüksek nedenlerde malign nedenlerin dışlanması gerekmektedir. Sugase ve ark.nın yaptığı olgu bildiriminde, hastamızda olduğundan daha düşük seviyelerdeki (1680 U/ml) CA 125 yüksekliğinde altta yatan minimal değişiklik hastalığına eşlik eden ovaryan malignite tespit edilmiştir (26). Sonuç olarak olası diğer nedenlerinin dışlanması ile CA 125 yüksekliğinin sebebinin nefrotik sendroma bağlı peritoneal ve plevral sıvının varlığı olduğu düşünüldü.…”

Do We Have to Perform a Renal Biopsy? Clinical Dilemmas in a Case with Nephrotic Syndrome

“…Performing a renal biopsy for proteinuric diabetics has usually been considered when the presence of a renal disease other than diabetic nephropathy is suggested by clinical signs, such as rapid deterioration of the renal function, microscopic or macroscopic hematuria, and proteinuria in newly diagnosed diabetics without retinopathy or neuropathy 5–7. On the other hand, the association of chronic renal insufficiency, nephrotic syndrome, and diabetes with microangiopathic complications such as retinopathy makes a diagnosis of diabetic nephropathy probable, diminishing the need for a renal biopsy 5,8,9.…”

“…Moreover, we should bear in mind that the time to remission of nephrotic syndrome after successful treatment of a malignancy can often be months to years 11,12,19. Nevertheless, the persistence of nephrotic syndrome with a progression of chronic renal failure in the current patient obliged us to perform a histological survey in view of the possibility of finding a potentially reversible glomerular lesion 7. One may argue that pathological assessment of the kidney is not warranted in the milieu of chronic renal insufficiency20; however, there was a clinical benefit to performing a renal biopsy in the present patient, because it led us to conclude that the presence of a latent relationship between nephrotic syndrome and gastric malignancy was unlikely, and that our patient was incidentally complicated with gastric carcinoma.…”

“…In addition, further investigations, such as bronchoscopy, gastroscopy, and CT, may be in order after the first-line assessment. 11,13 However, although some of these examinations may be carried out in the ordinary clinical setting, 7,15 the extent of the workup depends on the judgment of the primary physician. On the other hand, the validity of such a policy among the nephrotic patients whose renal pathological diagnoses are lacking or those with glomerulopathy other than membranous nephropathy remains to be established.…”