[Small cell pulmonary carcinoma, nephrotic syndrome and kidney failure of rapid evolution]

There are different clinical manifestations and various types of glomerular damages associated to neoplasias. The association to nephrotic syndrome is a relatively frequent event. However, rapidly evolutive renal insufficiency with extensive crescentic glomerulonephritis in more than 50% of the glomeruli is not usually thought to be linked to malignant diseases. We present the case of a previously healthy 55 year old man, who suffered a nephrotic syndrome and renal failure of rapid evolution, in whom a small cell lung cancer was detected. He died in three months and at autopsy mesangial proliferation and enlargement of basal membranes with crescents in 90% of the glomeruli were observed. Electronic microscopy also showed enlargement of the basal membrane. Structures consistent with immune-complex depositions were not seen. We reviewed the reported cases of glomerular lesions and neoplasias, and described the 20 cases published with this particular type of glomerular lesions described for the first time in 1976. None of these 20 cases belongs to this variety of lung cancer. Only in 5 patients, rapidly evolutive renal insufficiency was accompanied by nephrotic syndrome, as in the present case. The presence of immunocomplexes is not frequent and it was mentioned in only four cases. The only three cases of small cell lung carcinoma with nephrotic syndrome described in the literature were associated with membranous glomerulonephritis.