Nagai Kei, Tachi Hiroaki, Inoue Kohei, Ueda Atsushi
Department of Nephrology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Case Rep Nephrol. 2022 Sep 28;2022:8677293. doi: 10.1155/2022/8677293. eCollection 2022.
Malignant pleural mesothelioma is rarely associated with nephrotic syndrome. Cryoglobulinemia is found in various pathological statuses, such as hepatitis C virus infection but rarely in malignant neoplasms. We recently encountered a patient with malignant mesothelioma coincident with nephrotic syndrome and cryoglobulinemia in the course of chemotherapy. A 60-year-old man employed as a building painter was diagnosed with malignant mesothelioma by lung biopsy two years earlier and was started on chemotherapy. Nivolumab seemed effective in controlling mesothelioma, but skin immune-related adverse events occurred during the course of treatment. After discontinuation of nivolumab and administration of gemcitabine as an alternative therapy, the patient was referred to a nephrologist because of the subsequent development of edema, renal injury, and proteinuria. Following the investigation, he was diagnosed with nephrotic syndrome and cryoglobulinemia with C4-dominant cold activation. However, a percutaneous renal biopsy could not be performed due to persistent severe cough induced by pleural involvement. The patient died a little over three years after the pathological diagnosis of pleural mesothelioma. Our case had three key features nephrotic syndrome was possibly associated with malignant mesothelioma; cryoglobulinemia occurred in malignant mesothelioma; and concomitant nephrotic syndrome and cryoglobulinemia occurred after chemotherapy. Unfortunately, our rare case lacks a basis in renal pathology or evidence of links between the pathogenesis of malignant mesothelioma, cryoglobulinemia, and nephrotic syndrome. This case does not provide a causal mechanism, but may be worth adding to the case list as one of the rare renal involvement in a patient with malignant mesothelioma.
恶性胸膜间皮瘤很少与肾病综合征相关。冷球蛋白血症可见于多种病理状态，如丙型肝炎病毒感染，但在恶性肿瘤中很少见。我们最近遇到一名在化疗过程中同时患有恶性间皮瘤、肾病综合征和冷球蛋白血症的患者。一名60岁的男性建筑油漆工两年前经肺活检被诊断为恶性间皮瘤，并开始接受化疗。纳武单抗似乎对控制间皮瘤有效，但在治疗过程中出现了皮肤免疫相关不良事件。在停用纳武单抗并改用吉西他滨作为替代疗法后，患者因随后出现水肿、肾损伤和蛋白尿而被转诊至肾病科医生处。经过检查，他被诊断为肾病综合征和以C4为主的冷激活冷球蛋白血症。然而，由于胸膜受累导致持续严重咳嗽，无法进行经皮肾活检。该患者在胸膜间皮瘤病理诊断三年多后死亡。我们的病例有三个关键特征：肾病综合征可能与恶性间皮瘤相关；冷球蛋白血症发生在恶性间皮瘤中；化疗后同时出现肾病综合征和冷球蛋白血症。不幸的是，我们这个罕见病例缺乏肾脏病理学依据，也没有恶性间皮瘤、冷球蛋白血症和肾病综合征发病机制之间联系的证据。该病例并未提供因果机制，但作为恶性间皮瘤患者罕见肾脏受累情况之一，可能值得列入病例清单。
