Acute Kidney Injury in Rectal Cancer-Associated Minimal Change Disease: A Case Report
Journal of Nephrology & Therapeutics
A 75 year-old man presented with shortness of breath and increased bilateral lower extremity edema for 3 weeks. He was found to have nephrotic syndrome with a 24-hour urine protein excretion of 14 g. The serum creatinine had increased to 2.0 mg/dL from a baseline of 1.0 mg/dL within one month. Based on the initial presentation with shortness of breath and tachycardia, the patient was empirically treated with intravenous heparin infusion for suspected pulmonary embolism. The patient developed
... atient developed bleeding per rectum. Heparin was discontinued. A colonoscopy revealed a 6 cm rectosigmoid mass with biopsy showing moderately differentiated adenocarcinoma. A renal biopsy showed normal glomeruli on light microscopy and 100% foot process effacement on electron microscopy, consistent with minimal change disease (MCD). Treatment was initiated with prednisone 80 mg daily (1 mg/kg/d) and furosemide 40 mg twice daily orally. The patient underwent surgery and adjuvant chemoradiation. Lower extremity edema improved greatly over one month. Serum albumin increased to 2.6 g/dL Urine protein to creatinine ratio was 0.3. The serum creatinine returned to 1.0 mg/dL at baseline. Prednisone had been gradually tapered to 5 mg/day. Paraneoplastic glomerular disease is a rare manifestation of malignancy that is frequently mistaken from other glomerular diseases. In patients with nephrotic syndrome, especially elderly, the possibility of underlying malignancy should be considered. Colorectal cancer-associated MCD is uncommon and has been reported in only 6 cases to date. We present another case of rectal cancer-associated MCD with acute kidney injury and nephrotic syndrome. Considering that MCD is more steroid responsive than other nephrotic diseases, early recognition and diagnosis may help to expedite effective therapy. Also, ablation of the tumor frequently results in remission of MCD. Figure 1: A colonoscopy revealed a 6 cm rectosigmoid mass.