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Association between scleroderma, renal cell carcinoma and membranous nephropathy
S Nunez1, K N Konstantinov, K S Servilla
1Rheumatology Section, New Mexico Veterans Affairs Health Care System (VAHCS), NM, USA.
Clinical Nephrology
|February 11, 2009
Summary
A patient with scleroderma and membranous nephropathy experienced improvement after surgical removal of renal cell carcinoma (RCC). This case suggests a potential link between RCC and these autoimmune conditions.
Area of Science:
- Nephrology
- Oncology
- Rheumatology
Background:
- Scleroderma and membranous nephropathy (MN) are autoimmune conditions that can lead to significant morbidity.
- Renal cell carcinoma (RCC) is a common malignancy with varied presentations.
Observation:
- A 55-year-old male presented with rapidly progressing scleroderma, hypertension, and acute renal failure.
- He later developed nephrotic syndrome and progressive renal failure, with an unusual anti-nuclear mitotic apparatus protein (NUMA) antibody detected.
- A left upper pole renal cell carcinoma (RCC) was identified and surgically removed, with membranous nephropathy (MN) found adjacent to the tumor.
Findings:
- Following RCC resection, the patient experienced significant improvement in scleroderma symptoms and renal function.
- Proteinuria decreased, and serum creatinine levels stabilized post-surgery.
- The NUMA antibody, linked to malignancy, was present, further suggesting a connection.
Implications:
- This case highlights a potential paraneoplastic association between renal cell carcinoma, scleroderma, and membranous nephropathy.
- Surgical intervention for RCC may lead to remission of associated autoimmune renal and systemic manifestations.
- Further research is warranted to explore the pathogenetic mechanisms linking these conditions.
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