Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature

Our plain-English summary of Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature, by H. Yildiz, S.I. Andreea, D. Hoton, et al (BMJ Case Reports, 2016).

The study

• Authors: H. Yildiz, S.I. Andreea, D. Hoton, J.C. Yombi
• Journal: BMJ Case Reports
• Published: 2016;2016
• Type of article: Case report, Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 77-year-old man with a history of asbestos exposure was admitted to our internal medicine division for generalised weakness, fatigue, loss of weight, night sweats and difficulty for breathing since 3 months. Clinical examination revealed left fine crackles and bilateral leg oedema. Blood test showed elevated C reactive protein level at 142 mg/L, lactate dehydrogenase level at 421 UI, creatinine level at 5.75 mg/dL. Serum albumin level at 30 g/L, urinalysis showed significant proteinuria at 6.4 g/L. Chest X-ray showed left pleural effusion. Renal ultrasonography was normal. Thoracic CT and positron emission tomography showed mediastinal enlargement with lymphadenopathies and left pleural effusion and thickening. A pleural biopsy showed features compatible with malignant epithelioid mesothelioma. Renal biopsy showed minimal change disease and acute tubular necrosis. A diagnosis of malignant mesothelioma associated with minimal change disease and acute tubular necrosis secondary was then made. Given the poor general condition, palliative care was initiated and the patient died from respiratory failure 3 months later.

2016 BMJ Publishing Group Ltd.

In plain English

This was a case report from a hospital in Brussels, Belgium, with a review of earlier published cases. The patient, a 77-year-old man, had worked in construction before the 1980s and had been exposed to construction products containing asbestos; no fiber type was named. A pleural biopsy showed malignant epithelioid mesothelioma. Urine protein was 6.4 g/L and serum creatinine was 5.75 mg/dL. A kidney biopsy showed minimal change disease (a kidney disorder causing heavy loss of protein in the urine) and acute tubular necrosis. After steroids, urine protein fell to 1.8 g/day at one month, then rose to 4 g/day. The mesothelioma was not treated with chemotherapy. The patient received palliative care and died of respiratory failure 3 months after admission. The authors found 11 earlier reported cases of glomerular kidney disease with malignant pleural mesothelioma, all in men, with a mean age of 63 years. They wrote that whether the association was coincidental or causal remains speculative. They added that the failure to respond to steroids favoured a paraneoplastic syndrome (a disorder caused indirectly by a cancer).

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 review of previously published cases of glomerular disease in malignant pleural mesothelioma
• Who was studied: One 77-year-old man referred to the internal medicine division of Cliniques Universitaires Saint-Luc, Brussels, Belgium; the review covered 11 previously reported cases
• Exposure: Work as a construction worker before the 1980s, with exposure to construction products containing asbestos; no fiber type or dose given
• Main results:
  • In the patient, a pleural biopsy showed tumour cells diagnosed as malignant epithelioid mesothelioma
  • In the patient, urine protein was 6.4 g/L
  • In the patient, serum creatinine was 5.75 mg/dL (normal 0.6 to 1.3 mg/dL)
  • In the patient, a kidney biopsy showed minimal change disease and acute tubular necrosis
  • In the patient, after steroid treatment, urine protein fell to 1.8 g/day and creatinine to 1 mg/dL at one month
  • In the patient, the condition then worsened: urine protein rose to 4 g/day and creatinine to 3 mg/dL
  • The patient was given palliative care
  • The patient died of respiratory failure 3 months after admission
  • The literature review found 11 previously reported cases of glomerular disease with malignant pleural mesothelioma
  • In the 11 reviewed cases, all patients were men and their mean age was 63 years
  • In the 11 reviewed cases, urine protein was in the nephrotic range (more than 3 g/day) in 10 of 11 patients
  • In the reviewed cases, survival was 245.1 days (8 months). The authors compared this with a median survival of 9 to 15 months that another source reported for malignant pleural mesothelioma without kidney disease
• The authors' conclusion: The authors concluded that whether the association between minimal change disease and the mesothelioma was coincidental or causal remains speculative. They considered that the failure to respond to steroids favours a paraneoplastic syndrome.
• Limitations the authors state:
  • Because chemotherapy was not given, two of the four criteria for a paraneoplastic kidney disorder (a fall in urine protein with cancer treatment, and a rise with cancer relapse) could not be assessed
  • The mechanism linking mesothelioma and glomerular kidney disease is unknown

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Bilateral, Lactate Dehydrogenase (LDH), Chest X-Ray, Pleural Effusion, Pleural Biopsy, Epithelioid.

Related studies

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• Malignant pleural mesothelioma with associated minimal change disease and acute renal failure — J.Y. Li, T.Y. Yong, et al. (2010)
• Benign cystic mesothelioma associated with ipsilateral renal agenesis: a case report and review of literature — D. Murro, A. Harbhajanka, et al. (2014)
• Heterologous sarcomatoid pleural mesothelioma with osteosarcomatous differentiation: a report of autopsy case that accomplished trimodality therapy and review of the literature — H. Itano, T. Takeda, et al. (2020)
• Minimal pathologic changes of the lung and asbestos exposure — D. Bellis, A. Andrion, et al. (1989)
• Validation of a minimal panel of antibodies for the diagnosis of malignant pleural mesothelioma — S.C. Kao, K. Griggs, et al. (2011)

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