Komori Satoko, Nakazawa Eiko, Akimoto Tetsu, Meguro Daishi, Tozawa Ryoko, Muto Shigeaki, Kusano Eiji
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Nihon Jinzo Gakkai Shi. 2009;51(2):138-44.
A 73-year-old male with nephrotic syndrome was admitted to our hospital. He was empirically treated with prednisolone, which resulted in the alleviation of proteinuria, hypoproteinemia, and pleural effusion. Thereafter, a computed tomographic scan revealed a mass lesion in the right-lower lung field. Finally, the patient died of multiple organ failure induced by disseminated intravascular coagulation. Adenocarcinoma of the lung and membranous nephropathy (MN) were revealed by autopsy. MN tends to occur in the elderly, and is also occasionally associated with solid tumors, such as lung and gastrointestinal cancer. Therefore, a malignancy survey may be useful in the management of cases with nephrotic syndrome in which MN is pathologically defined. However, the initiation of empirical treatment without a pathological diagnosis is not an exceptional phenomenon. Physicians should, therefore, bear in mind the potential association of malignancy and immediately and carefully investigate the potential presence of a malignancy in elderly patients with a new onset of nephrotic syndrome.
一名73岁患有肾病综合征的男性入住我院。他接受了泼尼松龙经验性治疗,蛋白尿、低蛋白血症和胸腔积液得以缓解。此后,计算机断层扫描显示右下肺野有一肿块病变。最后,患者死于弥散性血管内凝血所致的多器官功能衰竭。尸检发现为肺腺癌和膜性肾病(MN)。MN倾向于发生在老年人中,也偶尔与实体瘤相关,如肺癌和胃肠道癌。因此,对于病理诊断为MN的肾病综合征患者,进行恶性肿瘤筛查可能有助于治疗。然而,在没有病理诊断的情况下开始经验性治疗并非罕见现象。因此,医生应牢记恶性肿瘤的潜在关联,并立即仔细调查新发性肾病综合征老年患者中潜在的恶性肿瘤情况。