Membranous nephropathy associated with malignant pleural mesothelioma in an adult patient: A case report

Our plain-English summary of Membranous nephropathy associated with malignant pleural mesothelioma in an adult patient: A case report, by X. Pu, Y. Dou, D. Liu, et al (Molecular and Clinical Oncology, 2016).

The study

• Authors: X. Pu, Y. Dou, D. Liu, S. Lu, S. Quan, X. Zhang, S. Ma, Z. Zhao
• Journal: Molecular and Clinical Oncology
• Published: 2016;5(4):407-410
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 23-year-old man presented to our hospital with membranous nephropathy and received a detailed examination, including pleural biopsy, due to a feeling of chest oppression. The result of the pleural biopsy was malignant pleural mesothelioma. However, the patient did not have a history of asbestos or tobacco exposure. A review of the English literature identified only 7 reported cases of concomitant malignant mesothelioma and nephrotic syndrome. Furthermore, among the 7 cases reviewed, 6 had a history of asbestos exposure, 1 had a history of prolonged tobacco exposure and in only 1 case the renal pathology results revealed the presence of membranous nephropathy.

In plain English

This was a case report from a nephrology department in Zhengzhou, China, with a short review of earlier published cases. A 23-year-old man was admitted in September 2014. Four years earlier the patient had been diagnosed with nephrotic syndrome, and a kidney biopsy had shown membranous nephropathy. After chest oppression developed, a pleural biopsy with immunohistochemical staining led to a diagnosis of malignant pleural mesothelioma. The patient had no history of asbestos or tobacco exposure. A blood test for anti-PLA2R antibody was negative. After one cycle of pemetrexed and cisplatin chemotherapy, urine protein fell. When bone marrow suppression delayed the second cycle, 24-hour urine protein rose to 13.78 g. The patient died two weeks after the second cycle from extensive spread of the disease and severe infection. The authors found 7 earlier reported cases of nephrotic syndrome with malignant mesothelioma in the English literature. Of these, 6 had asbestos exposure, 1 had prolonged tobacco exposure, and 1 had membranous nephropathy. The authors hypothesized that there are certain correlations between malignant mesothelioma and membranous nephropathy.

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 of one patient, with a brief review of previously published cases
• Who was studied: one 23-year-old man admitted on September 5, 2014 to the First Affiliated Hospital of Zhengzhou University, China; plus 7 earlier cases from the English literature
• Exposure: the patient had no history of asbestos or tobacco exposure; in the reviewed literature, 6 of 7 cases had a history of asbestos exposure (fiber types not stated)
• Main results:
  • Four years before admission the patient had nephrotic syndrome (urine protein 10.39 g per day, serum albumin 15 g per litre), and a renal biopsy confirmed membranous nephropathy
  • On pleural biopsy, immunohistochemistry was positive for CK19, CD5, CR, HBME-1, Ki-67, WT-1 and CK5/6 and negative for TTF-1 and CEA. The patient was diagnosed with membranous nephropathy associated with malignant pleural mesothelioma
  • The anti-PLA2R antibody test was negative in this patient
  • After the first cycle of pemetrexed and cisplatin, urine protein fell to 1+. When the second cycle was delayed by myelosuppression, 24-hour urine total protein rose to 13.78 g
  • The patient died 2 weeks after the second chemotherapy cycle
  • Of 7 previously reported cases of nephrotic syndrome with malignant mesothelioma, 6 had a history of asbestos exposure, 1 had prolonged tobacco exposure, and 1 had membranous nephropathy on renal pathology
• The authors' conclusion: The authors hypothesized that there are certain correlations between malignant mesothelioma and membranous nephropathy, and stated that secondary causes must be excluded when membranous nephropathy is diagnosed

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Biopsy, Malignant Mesothelioma, Asbestos Exposure, Pathology.

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