Cryofibrinogen-associated glomerulonephritis accompanied by advanced gastric cancer
Cryofibrinogen-associated glomerulonephritis accompanied by advanced gastric cancer
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DOI：
10.1007/s13730-021-00602-0
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发表时间：
2021-04-27
期刊：
影响因子：
1
通讯作者：
Kinugawa, Koichiro
中科院分区：
文献类型：
--
作者：
Kakeshita, Kota;Yamazaki, Hidenori;Kinugawa, Koichiro
我们有一个72岁的男性晚期胃癌，低分化腺癌，接受化疗S-1（替加富，吉美拉西和奥他拉西钾）加奥沙利铂。尽管胃癌缓解和转移，腹水仍然发生。鉴于腹水、腿部水肿、肾功能损害、低白蛋白血症和大量蛋白尿中没有恶性细胞，我们诊断为肾病综合征伴镜下血尿。肾活检显示膜增生性肾小球肾炎，未见免疫球蛋白和补体沉积。值得注意的是，电子显微镜在肾小球毛细血管管腔和内皮下腔内发现有组织的微管结构沉积物。液相色谱-串联质谱法检测纤维蛋白原α链、β链、γ链和纤维连接蛋白，最终诊断为低温纤维蛋白原相关性肾小球肾炎。血浆中未检出低温纤维蛋白原。由于难治性肾病综合征的进展，他在肾活检后5个月死亡。除了对特定组织沉积物的详细评估外，液相色谱-串联质谱分析方法对诊断低温纤维蛋白原相关的肾小球肾炎也很有用。虽然低温纤维蛋白原相关性肾小球肾炎是一种罕见的疾病，但当恶性肿瘤患者出现尿分析异常和肾脏损害时，我们应考虑鉴别诊断。
We had a 72-year-old man with advanced gastric cancer, poorly differentiated adenocarcinoma, receiving chemotherapy with S-1 (tegafur, gimeracil, and oteracil potassium) plus oxaliplatin. Ascites developed despite remission of gastric cancer and metastasis. Given no malignant cells in ascites, leg edema, renal impairment, hypoalbuminemia, and massive proteinuria, we diagnosed as nephrotic syndrome with microscopic hematuria. Renal biopsy showed membranoproliferative glomerulonephritis with no deposition of immunoglobulins and complements. Of note, electronic microscopy found organized deposits with microtubular structures in the glomerular capillary lumens and subendothelial spaces. The liquid chromatography-tandem mass spectrometry method detected fibrinogen alpha chain, beta chain, gamma chain, and fibronectin, and we eventually diagnosed cryofibrinogen-associated glomerulonephritis. Cryofibrinogen was not detected in plasma. He was expired at 5 months following renal biopsy due to the progression of refractory nephrotic syndrome. In addition to the detailed assessment of specifically organized deposits, the analysis using liquid chromatography-tandem mass spectrometry method is useful to diagnose cryofibrinogen-associated glomerulonephritis. We should consider cryofibrinogen-associated glomerulonephritis as a differential diagnosis when the patients with malignancy showed abnormal urinalysis and renal impairment, though it is a rare disease.