Yu Ling, Wang Jingjing, Feng Chunyue, Huang Guoping, Gu Weizhong, Xiong Jieni, Mao Jianhua
Department of Nephrology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN.
Department of Pathology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN.
Cureus. 2024 May 11;16(5):e60089. doi: 10.7759/cureus.60089. eCollection 2024 May.
Concurrent malignancy and IgA nephropathy are rare. Despite the lack of solid experimental evidence, there are theoretical hypotheses of pathophysiology for the development of glomerular damage in cancer patients, like aberrant immune activities. Here, we describe a nine-year-old child who was admitted due to nephrotic syndrome. Abdominal imaging examination accidentally revealed a retroperitoneal tumor, and surgical resection was performed with a pathological diagnosis of neuroblastoma. However, complete removal of the tumor had no impact on the clinical manifestation of nephrotic syndrome, like proteinuria. The use of corticosteroids alone only led to a partial resolution of proteinuria, and resistance developed after one month of treatment. A further kidney biopsy was performed, which suggested IgA nephropathy. Clinical remission of IgA nephropathy was achieved after standard combination treatment of corticosteroids and mycophenolate mofetil for 10 months. This study represented the first case report of neuroblastoma associated with IgA nephropathy. We postulated that IgA nephropathy pathogenesis might be associated with neuroblastoma, though a coincidence of these two conditions cannot be fully excluded. Standard treatment for IgA nephropathy is applicable for patients with concomitant cancer.
并发恶性肿瘤和IgA肾病很罕见。尽管缺乏确凿的实验证据，但对于癌症患者肾小球损伤的发生发展存在一些病理生理学的理论假说，比如异常免疫活动。在此，我们描述一名因肾病综合征入院的9岁儿童。腹部影像学检查意外发现腹膜后肿瘤，行手术切除，病理诊断为神经母细胞瘤。然而，肿瘤的完全切除对肾病综合征的临床表现，如蛋白尿，并无影响。单独使用糖皮质激素仅使蛋白尿部分缓解，治疗1个月后出现耐药。进一步进行肾活检，提示为IgA肾病。糖皮质激素与霉酚酸酯标准联合治疗10个月后，IgA肾病实现临床缓解。本研究是神经母细胞瘤合并IgA肾病的首例病例报告。我们推测IgA肾病的发病机制可能与神经母细胞瘤有关，尽管不能完全排除这两种情况只是巧合。IgA肾病的标准治疗适用于合并癌症的患者。
