Furuzono Nozomi, Togami Shinichi, Oi Honami, Iwao Aoi, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, JPN.
Cureus. 2025 May 8;17(5):e83750. doi: 10.7759/cureus.83750. eCollection 2025 May.
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.
恶性肿瘤患者的急性肾损伤（AKI）通常由尿路梗阻、肿瘤浸润或代谢紊乱引起。然而，副肿瘤性肾小球病仍然是AKI的一种罕见且未被充分认识的病因，尤其是在妇科恶性肿瘤中。我们报告一例21岁女性，她因腹胀和盆腔巨大肿块就诊。影像学和实验室检查数据提示国际妇产科联盟（FIGO）IIIC期恶性卵巢生殖细胞肿瘤。入院时肾功能明显异常，强化液体复苏治疗无效。患者无肾积水、感染或电解质异常迹象。尽管给予了支持治疗，但其肾功能仍持续恶化，遂开始持续血液透析滤过（CHDF）治疗。由于临床症状持续进展，遂进行了急诊肿瘤减瘤手术。组织病理学证实为混合性恶性卵巢生殖细胞肿瘤，主要由无性细胞瘤和卵黄囊瘤成分组成。术后，她的肾功能迅速改善，术后第5天停止了CHDF治疗。术后第17天开始给予全量博来霉素、依托泊苷和顺铂化疗，化疗过程中未减量且未出现严重毒性反应。目前，患者仍处于完全缓解状态。该病例提示副肿瘤性肾小球病可能是卵巢生殖细胞肿瘤患者AKI 的可逆病因。肿瘤切除术后肾功能的显著改善支持了这一假说。在本病例中，及时的手术干预不仅解决了肾功能损害问题，还为及时进行根治性化疗创造了条件。据我们所知，这是首份提示副肿瘤性肾小球功能障碍与恶性卵巢生殖细胞肿瘤之间存在关联的报告。
