Multicentric Castleman's disease associated with glomerular microangiopathy and MPGN-like lesion: does vascular endothelial cell-derived growth factor play causative or protective roles in renal injury?

Monoclonality and cytogenetic abnormalities in hyaline vascular Castleman disease

“…The compressed sinuses result in the lymph node being a closed system that sequesters soluble factors or cytokines in the lymph node that could subsequently lead to overgrowth of stromal cells. [31][32][33] As hyaline vascular Castleman diseases of larger size and with stromal overgrowth were monoclonal in almost all cases, it indicates that the monoclonal proliferation of stromal cells become more prominent with time.…”

Fracaso renal agudo por microangiopatía trombótica asociado a enfermedad de Castleman

“…Las plaquetas son trasportadoras de dicho factor, la liberación de VEGF aumenta la permeabilidad vascular y la actividad coagulante plasmática en vivo. En un caso descrito por Seida et al (15) se detectó una importante elevación de VEGF y el paciente, al igual que el nuestro, mostró trombocitopenia y coagulación intravascular diseminada. Mediante inmuno-marcaje de VEFG, demostraron que los nódulos linfáticos con proliferación de células plasmáticas eran uno de los sitios de mayor producción de VEGF, explicando la aparición de derrame pleural, la ascitis, el edema generalizado y la aparición de proteinuria por el aumento de la permeabilidad vascular.…”

“…Recientemente, VEGF ha sido implicado en la protección e incluso en la aceleración de la recuperación del daño renal de la microangiopatía trombótica inducida por anticuerpos contra el endotelio en modelos experimentales en ratas (16,17). Así, el daño endotelial y la microangiopatía trombóti-ca estarían inducidas por la enfermedad de Castleman y posteriormente la producción local de VEGF podría proteger y acelerar la recuperación del daño glomerular (15).…”

Membranoproliferative Glomerulonephritis in Castleman's Disease: A Systematic Review of the Literature and 2 Case Reports

“…Most patients have been treated with alternative pharmacotherapies such as interferon-alpha (IFN-a), thalidomide, rituximab, bortezomib, anti-IL-6 receptor antibodies, corti-costeroids and chemotherapy, per different etiology and pathogenesis of CD. When the therapies of the 6 previously reported cases were compared (Table 2), Three used corticosteroids as a single-agent therapy (2,4,6). In one special case, combination therapy replaced single steroid therapy halfway due to disease recurrence (5).…”

“…Because CD with renal complications is easily clinically misdiagnosed or ignored, nephrologists must remain vigilant. There have been only reports of seven MPGN/ MPGN-like cases associated with CD, among which six reports were in the English language and indexed by the PubMed database (2)(3)(4)(5)(6)(7). Together with the relevant literature review, we herein report 2 cases of MPGN lesion in multicentric type CD (MCD): one is MPGN of hyaline vascular variant (HVV) and the other is MPGN of mixed variant.…”