Remission of nephrotic syndrome after surgical intervention for bronchogenic carcinoma: the 10-year follow-up of a patient with membranous nephropathy

Abstract

Izumi Nagayama,1 Tetsu Akimoto,1,2 Yuko Ono,3 Yoshihiko Ueda,3 Daisuke Nagata1 1Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan; 2Department of Chronic Kidney Disease Pathophysiology, Jichi Medical University, Shimotsuke, Tochigi, Japan; 3Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan Abstract: Nephrotic syndrome (NS) is a pivotal manifestation of glomerular injury associated with various types of neoplasms. It may either precede or act as the presenting feature of the disease, whereas membranous nephropathy (MN) is a major phenotype of paraneoplastic glomerulopathies. However, there is a lack of information regarding the remission from paraneoplastic NS due to MN in patients who achieve favorable long-term survival after the successful removal of malignant tissue. We, herein, describe a case of biopsy-proven MN in a 65-year-old male patient with bronchogenic carcinoma, which was found during the systemic workup for concurrent NS. He was successfully treated with thoracoscopic left lower lobectomy and achieved a complete remission from NS at approximately 10 months after radical surgery. In 10 years of follow-up, there has been no recurrence of the pulmonary cancer and the patient is doing well with no relapse of NS, despite having never received treatment with any type of immunomodulating agent. Several concerns, including diagnostic management and therapeutic strategies for paraneoplastic NS, are discussed. Keywords: nephrotic syndrome, paraneoplastic kidney disease, membranous nephropathy, pulmonary cancer, remission

Keywords

• Nephrotic syndrome
• paraneoplastic kidney disease
• membranous nephropathy
• pulmonary cancer
• remission