Reversible Acute Kidney Injury Due to Suspected Paraneoplastic Glomerulopathy in Malignant Ovarian Germ Cell Tumor: A Case Report.

Acute kidney injury (AKI) in patients with malignancies is typically caused by urinary obstruction, tumor infiltration, or metabolic derangements. However, paraneoplastic glomerulopathy remains an uncommon and under-recognized etiology of AKI, particularly in gynecologic malignancies. We describe the case of a 21-year-old woman who presented with abdominal distension and a large pelvic mass. Imaging and laboratory data suggested an International Federation of Gynecology and Obstetrics stage IIIC malignant ovarian germ cell tumor. Renal dysfunction was evident on admission and did not respond to intensive fluid resuscitation. The patient showed no signs of hydronephrosis, infection, or electrolyte abnormalities. Despite supportive care, her renal function continued to deteriorate, and continuous hemodiafiltration (CHDF) was initiated. Due to progressive clinical decline, emergency tumor debulking surgery was performed. Histopathology confirmed a mixed malignant ovarian germ cell tumor composed primarily of dysgerminoma and yolk sac tumor elements. Postoperatively, her renal function improved rapidly, and CHDF was discontinued by postoperative day 5. Full-dose bleomycin, etoposide, and cisplatin chemotherapy was commenced on postoperative day 17 and completed without dose reduction or major toxicity. Currently, the patient remains in complete remission. This case suggests the possibility of paraneoplastic glomerulopathy as a reversible cause of AKI in patients with ovarian germ cell tumors. The dramatic improvement in renal function after tumor resection supports this hypothesis. In this case, prompt surgical intervention not only resolved the renal impairment but also allowed for the timely administration of curative chemotherapy. To our knowledge, this is the first report to suggest an association between paraneoplastic glomerular dysfunction and malignant ovarian germ cell tumors.