Abstract: SA-PO248
ANCA Negative Pauci-Immune Crescentic Glomerulonephritis Associated with Cervical Carcinoma
Session Information
- Trainee Case Reports - V
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Kumar, Ujjala, UCSD, San Diego, California, United States
- Bolourian kashi, Kioumars, UCSD, San Diego, California, United States
- Miracle, Cynthia, UCSD, San Diego, California, United States
- Cruz, Dinna, University of California San Diego, San Diego, California, United States
- Novikov, Aleksandra, UCSD, San Diego, California, United States
- Karl, Bethany E., UCSD, San Diego, California, United States
Introduction
Glomerulonephritis (GN) associated with solid tumors is a rare but well-known entity. Various forms of paraneoplastic GN have been described in the literature, most common being membranous and minimal change disease. Here we present a case of cervical cancer and rapidly progressive crescentic GN involving near 100% of the glomeruli sampled.
Case Description
A 58-year-old woman admitted for rising creatinine found on routine labs prior to initiation of chemotherapy. Medical history was significant for recently diagnosed poorly differentiated cervical carcinoma, AJCC stage IIB., for which she had been actively receiving radiation therapy. She denied prior kidney disease, use of non-steroidals nor recent antibiotics. On presentation, Cr was 2.4 mg/dL from baseline of 0.9 mg/dL a month prior to presentation. Urinalysis revealed active sediments. 24-hour urine quantified proteinuria in nephrotic range (8 gms/24-hr). Extensive GN work-up was negative. Serum protein electrophoresis and urine immunofixation showed no monoclonal gammopathy. A renal ultrasound showed normal size kidneys. A kidney biopsy divulged severe, active necrotizing and crescentic glomerulonephritis involving nearly 100% of 22 sampled glomeruli. There were cellular crescents and amyloidosis, type AA, with extensive glomerular and focal vascular involvement. Acute tubular injury and extensive tubulointerstitial inflammation were also noted. Patient’s renal function continued to deteriorate in parallel to progression of her malignancy and was eventually started on hemodialysis five months after her initial diagnosis of GN. Unfortunately, patient was never deemed a candidate for chemotherapy due to poor performance status. She continued to decline and transitioned to comfort care passing less than 7 months from her initial renal diagnosis.
Discussion
We present a unique case of rapidly progressive crescentic GN associated with cervical cancer. There have been cases of membranous glomerulonephritis associated with cervical cancer but crescentic GN has not been reported in the literature to the best of our knowledge. As in other cases of paraneoplastic GN, treatment targeted towards the cancer results in resolution of the GN in most cases but our patient was not a chemotherapy candidate and her disease ultimately progressed to end stage renal disease.