Malignant pleural mesothelioma with associated minimal change disease and acute renal failure

Our plain-English summary of Malignant pleural mesothelioma with associated minimal change disease and acute renal failure, by J.Y. Li, T.Y. Yong, B.J. Kuss, et al (Renal Failure, 2010).

The study

• Authors: J.Y. Li, T.Y. Yong, B.J. Kuss, S. Klebe, D. Kotasek, J.A. Barbara
• Journal: Renal Failure
• Published: 2010;32(8):1012-5
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Paraneoplastic manifestations in malignant pleural mesothelioma are rare. We report a case of malignant pleural mesothelioma associated with minimal change disease (MCD). A 58-year-old man with occupational exposure to asbestos presented with severe peripheral edema, heavy proteinuria, and acute renal failure shortly after the diagnosis of mesothelioma had been confirmed. The renal biopsy demonstrated MCD. The underlying pathogenesis of this association remains unknown.

In plain English

This case report described one 58-year-old man, a builder who had been exposed to asbestos. No fiber type was named. A biopsy taken during chest surgery showed epithelial-type diffuse malignant pleural mesothelioma. Two weeks later he developed swelling, fatigue, worsening breathlessness and reduced urine output. Tests showed acute kidney failure with dangerously high potassium, and he needed urgent dialysis in intensive care. His blood creatinine was 330 μmol/L, compared with 95 μmol/L at the time of surgery. Tests also showed nephrotic syndrome, meaning heavy protein loss in the urine. A kidney biopsy showed acute tubular necrosis and a pattern characteristic of minimal change disease. After chemotherapy his blood counts fell, kidney failure persisted, and he died of sepsis 6 weeks after first presenting. The authors counted seven earlier English-language reports of glomerular disease with mesothelioma. They called this the first case of kidney failure associated with both minimal change disease and mesothelioma to need dialysis. They suggested that the need for dialysis may well have contributed to his limited survival. They stated that the cause of the association remains unknown.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a comparison to previously published cases
• Who was studied: One 58-year-old man, a builder; the authors are from Flinders Medical Centre and Flinders University, Adelaide, South Australia, and the Adelaide Cancer Centre
• Exposure: Occupational exposure to asbestos as a builder; fiber type and dose not stated
• Main results:
  • The patient's chest biopsy showed epithelial-type diffuse malignant pleural mesothelioma
  • Two weeks later the patient developed peripheral edema (swelling), fatigue, worsening breathlessness and reduced urine output
  • The patient had acute renal failure with life-threatening hyperkalemia (high potassium) and was admitted to intensive care for urgent hemodialysis
  • The patient's serum creatinine was 330 μmol/L (reference range 60 to 120 μmol/L)
  • The patient's kidney function had been normal at the time of chest surgery (creatinine 95 μmol/L)
  • The patient had nephrotic syndrome, with serum albumin of 15 g/L and more than 3 g/L of protein in the urine
  • The patient's kidney biopsy showed features consistent with acute tubular necrosis
  • Electron microscopy of the patient's kidney biopsy showed a pattern characteristic of minimal change disease (MCD)
  • Chemotherapy (gemcitabine and carboplatin) led to pancytopenia (low counts of all blood cell types) requiring transfusions
  • The patient's kidney failure and pancytopenia persisted after treatment
  • The patient died of sepsis 6 weeks after first presentation
  • In the authors' review of the literature, only seven earlier cases of glomerular (kidney filter) disease associated with malignant mesothelioma had been reported in the English medical literature
  • Of those seven earlier cases, three were associated with MCD
  • The authors stated this was the first case to require dialysis for renal failure associated with both MCD and mesothelioma
  • The authors stated the case met the first two of four criteria for paraneoplastic nephrotic syndrome: no other cause, and onset within 6 months of the cancer diagnosis. The patient died shortly after treatment, so the treatment-response criteria could not be assessed
  • The authors stated the underlying mechanism linking MCD and mesothelioma is unknown
• The authors' conclusion: The authors concluded that the prognosis was poor and that the need for hemodialysis may well have contributed to the patient's limited survival. They also stated that treating the mesothelioma may improve this kidney complication but is unlikely to improve the overall prognosis.
• Limitations the authors state:
  • A 24-hour urine protein measurement was not done because the patient had oliguric renal failure (very low urine output)

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Occupational Exposure, Mesothelioma, Biopsy.

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