"Horseshoe kidney", renal adenocarcinoma and nephrotic syndrome
Riñón en herradura, adenocarcinoma renal y síndrome nefrótico
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Rivera, G. Caparrós, C. Vozmediano, M. Bennouna, S. Anaya, M.D. Sánchez de la Nieta, M. García Rojo, J. Blanco" "autores" => array:8 [ 0 => array:4 [ "Iniciales" => "F." "apellidos" => "Rivera" "email" => array:1 [ 0 => ": friverahdez@senefro.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "G." "apellidos" => "Caparrós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "C." "apellidos" => "Vozmediano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "M." "apellidos" => "Bennouna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "S." "apellidos" => "Anaya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "Iniciales" => "M.D." "apellidos" => "Sánchez de la Nieta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "Iniciales" => "M." "apellidos" => "García Rojo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 7 => array:3 [ "Iniciales" => "J." "apellidos" => "Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Ciudad Real, Ciudad Real, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General de Ciudad Real, Ciudad Real, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Riñón en herradura, adenocarcinoma renal y síndrome nefrótico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10550_108_9219_en_10550_t1.jpg" "Alto" => 430 "Ancho" => 721 "Tamanyo" => 56373 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">“Horseshoe” kidney (HK) is one of the most common congenital malformations of the genitourinary system.<span class="elsevierStyleSup">1</span> It is often associated with other renal or extrarenal anomalies, among which are tumours<span class="elsevierStyleSup">2</span> and several types of glomerular diseases.<span class="elsevierStyleSup">3</span> We describe a patient with HK, renal adenocarcinoma (RAC) and nephrotic syndrome with morphological substrate of focal segmental glomerulosclerosis (FSG) as well as the possible relationship between the two.</p><p class="elsevierStylePara">We present the case of a 38-year-old male patient referred for nephrotic syndrome. He is a smoker, has Hodgkin’s disease and ischaemic heart disease. He is found to have a HK in a routine ultrasound.</p><p class="elsevierStylePara">A week before admittance (October 2007), he starts showing symptoms of oedemas. The biochemistry showed: proteinuria 18g/24h, serum albumin 2.1g/dl and hyperlipaemia, associated with microhematuria and serum creatinine 1.6mg/dl. Examination results: blood pressure 103/60mmHg, body mass index (BMI) 21kg/m<span class="elsevierStyleSup">2 </span>and generalised oedemas. Normal haemogram and coagulation study. ANA, anti-DNA, ANCAS, anti-MBG antibodies, cryoglobulins, lupus anticoagulant, anticardiolipin antibodies and hepatitis B and C antivirus antibodies as well as human immunodeficiency virus (HIV), all negative. The ultrasound and CT scan confirmed HK, with a tumour on the upper pole of the right kidney (Figure 1a). The cystography was normal. A nephrectomy with exeresis of the inferior isthmus is performed. Following surgery there was localised bleeding and partially recovered acute renal failure (creatinine 3mg/dl).</p><p class="elsevierStylePara">The piece removed in the nephrectomy measured 14x6cm with a tumour measuring 4x4.5cm. The microscopic study confirms renal adenocarcinoma with a pattern of chromophobe and eosinophilic cells (Figure 1b). The renal vein was not infiltrated.</p><p class="elsevierStylePara">The optical microscope study of an adjacent wedge displayed larger glomeruli, some of which were hyalinised. In the rest, there was an increase in the mesangial matrix and capillary collapse with several foam cells, interstitial fibrosis and infiltration of inflammatory cells. Mesangial and parietal deposits of IgM and C3 were detected in the immunofluorescence with segmental and focal distribution (Figure 1c and Figure 1d).</p><p class="elsevierStylePara">The patient maintained nephrotic syndrome in subsequent check-ups, which was treated with simvastastin, dicumarol, losartan and prednisone. He presented high digestive haemorrhage and spontaneous peritonitis in the following months, these improved with medical treatment and discontinuation of steroids. The clinical and biochemical nephrotic syndrome is maintained with progressive deterioration in kidney function, nephrogenic anaemia and hypothyroidism, pending dialysis.</p><p class="elsevierStylePara">HK can be associated with several renal tumours. Over 200 cases have been reported of which RAC is a distinguishing feature.<span class="elsevierStyleSup">2,4</span> However, other types of tumours have been described such as transitional cell carcinoma, Wilms’ tumour, nephroblastoma, carcinoid, sarcoma and oncocytoma. Urinary stasis, infections and abnormal embryogenesis may also be involved in its pathogenesis.</p><p class="elsevierStylePara">The association between HK and several glomerular diseases has also been reported (Table 1).<span class="elsevierStyleSup">3,5-11</span> In certain cases, this association is a coincidence,<span class="elsevierStyleSup">5,6</span> but in other cases it is believed that the HK predisposes the glomerular diseases because it facilitates immune complex deposition.<span class="elsevierStyleSup">7-9</span> In our case, we demonstrated the presence of corticoresistant FSG, with glomerulomegaly, not associated with obesity or vesicoureteral reflux. Although it has been accepted that FSG secondary to hyperfiltration does not develop complete nephrotic syndrome despite massive proteinuria,<span class="elsevierStyleSup">12</span> our case would not be considered under this rule.</p><p class="elsevierStylePara">Lastly, several renal or extrarenal tumours could be associated with several types of glomerulopathies: with minimal changes, IgA nephropathy, membranous, extracapillary proliferative and amyloidosis.<span class="elsevierStyleSup">10,13-15</span> Most authors that have described the association between RAC and FSG reach the conclusion that the most determining factor is glomerular hyperfiltration due to reduction of functioning renal mass, as we believe has occurred with our patient.</p><p class="elsevierStylePara">To summarise, HK can be associated with RAC and nephrotic syndrome with FSG secondary to hyperfiltration which evolves towards chronic renal failure.</p><p class="elsevierStylePara"><a href="grande/10550_108_9219_en_10550_t1.jpg" class="elsevierStyleCrossRefs"><img src="10550_108_9219_en_10550_t1.jpg"></img></a></p><p class="elsevierStylePara">Table 1. "Horseshoe" kidney and glomerular diseases</p><p class="elsevierStylePara"><a href="grande/10550_108_9220_en_10550_f1.jpg" class="elsevierStyleCrossRefs"><img src="10550_108_9220_en_10550_f1.jpg" alt="a) Abdominal CT: horseshoe kidney with mass on the upper pole of the right kidney (arrows), b) renal adenocarcinoma with tumour cells with papillary structures, c) large glomeruli with thickening of the capillary wall, d) mesangial and parietal IgM deposi"></img></a></p><p class="elsevierStylePara">Figure 1. a) Abdominal CT: horseshoe kidney with mass on the upper pole of the right kidney (arrows), b) renal adenocarcinoma with tumour cells with papillary structures, c) large glomeruli with thickening of the capillary wall, d) mesangial and parietal IgM deposi</p>" "pdfFichero" => "P1-E503-S2294-A10550-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10550_108_9219_en_10550_t1.jpg" "Alto" => 430 "Ancho" => 721 "Tamanyo" => 56373 ] ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10550_108_9220_en_10550_f1.jpg" "Alto" => 977 "Ancho" => 1393 "Tamanyo" => 222265 ] ] "descripcion" => array:1 [ "en" => "a) Abdominal CT: horseshoe kidney with mass on the upper pole of the right kidney (arrows), b) renal adenocarcinoma with tumour cells with papillary structures, c) large glomeruli with thickening of the capillary wall, d) mesangial and parietal IgM deposi" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Waters AM, Rosenblum ND. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 54 | 33 | 87 |
| 2024 September | 60 | 30 | 90 |
| 2024 August | 92 | 60 | 152 |
| 2024 July | 55 | 36 | 91 |
| 2024 June | 72 | 36 | 108 |
| 2024 May | 98 | 46 | 144 |
| 2024 April | 70 | 30 | 100 |
| 2024 March | 49 | 25 | 74 |
| 2024 February | 41 | 45 | 86 |
| 2024 January | 35 | 25 | 60 |
| 2023 December | 36 | 27 | 63 |
| 2023 November | 50 | 32 | 82 |
| 2023 October | 45 | 30 | 75 |
| 2023 September | 49 | 29 | 78 |
| 2023 August | 44 | 30 | 74 |
| 2023 July | 65 | 25 | 90 |
| 2023 June | 47 | 29 | 76 |
| 2023 May | 54 | 30 | 84 |
| 2023 April | 30 | 18 | 48 |
| 2023 March | 44 | 32 | 76 |
| 2023 February | 42 | 25 | 67 |
| 2023 January | 51 | 22 | 73 |
| 2022 December | 49 | 38 | 87 |
| 2022 November | 44 | 35 | 79 |
| 2022 October | 51 | 42 | 93 |
| 2022 September | 39 | 30 | 69 |
| 2022 August | 30 | 64 | 94 |
| 2022 July | 45 | 40 | 85 |
| 2022 June | 76 | 40 | 116 |
| 2022 May | 36 | 33 | 69 |
| 2022 April | 47 | 64 | 111 |
| 2022 March | 41 | 34 | 75 |
| 2022 February | 51 | 45 | 96 |
| 2022 January | 52 | 40 | 92 |
| 2021 December | 39 | 42 | 81 |
| 2021 November | 45 | 38 | 83 |
| 2021 October | 54 | 42 | 96 |
| 2021 September | 42 | 39 | 81 |
| 2021 August | 36 | 36 | 72 |
| 2021 July | 48 | 38 | 86 |
| 2021 June | 33 | 30 | 63 |
| 2021 May | 86 | 30 | 116 |
| 2021 April | 114 | 48 | 162 |
| 2021 March | 61 | 26 | 87 |
| 2021 February | 78 | 16 | 94 |
| 2021 January | 69 | 20 | 89 |
| 2020 December | 65 | 13 | 78 |
| 2020 November | 45 | 15 | 60 |
| 2020 October | 44 | 20 | 64 |
| 2020 September | 48 | 13 | 61 |
| 2020 August | 45 | 6 | 51 |
| 2020 July | 47 | 6 | 53 |
| 2020 June | 37 | 12 | 49 |
| 2020 May | 63 | 12 | 75 |
| 2020 April | 45 | 15 | 60 |
| 2020 March | 44 | 12 | 56 |
| 2020 February | 66 | 19 | 85 |
| 2020 January | 56 | 14 | 70 |
| 2019 December | 55 | 23 | 78 |
| 2019 November | 53 | 16 | 69 |
| 2019 October | 37 | 9 | 46 |
| 2019 September | 47 | 18 | 65 |
| 2019 August | 46 | 9 | 55 |
| 2019 July | 42 | 16 | 58 |
| 2019 June | 42 | 10 | 52 |
| 2019 May | 32 | 14 | 46 |
| 2019 April | 69 | 28 | 97 |
| 2019 March | 38 | 17 | 55 |
| 2019 February | 28 | 23 | 51 |
| 2019 January | 49 | 23 | 72 |
| 2018 December | 79 | 31 | 110 |
| 2018 November | 162 | 19 | 181 |
| 2018 October | 129 | 13 | 142 |
| 2018 September | 84 | 21 | 105 |
| 2018 August | 54 | 13 | 67 |
| 2018 July | 63 | 10 | 73 |
| 2018 June | 51 | 13 | 64 |
| 2018 May | 82 | 17 | 99 |
| 2018 April | 68 | 10 | 78 |
| 2018 March | 61 | 9 | 70 |
| 2018 February | 75 | 5 | 80 |
| 2018 January | 82 | 7 | 89 |
| 2017 December | 71 | 12 | 83 |
| 2017 November | 38 | 9 | 47 |
| 2017 October | 39 | 8 | 47 |
| 2017 September | 45 | 12 | 57 |
| 2017 August | 38 | 12 | 50 |
| 2017 July | 32 | 19 | 51 |
| 2017 June | 36 | 11 | 47 |
| 2017 May | 77 | 11 | 88 |
| 2017 April | 56 | 10 | 66 |
| 2017 March | 41 | 9 | 50 |
| 2017 February | 58 | 9 | 67 |
| 2017 January | 48 | 15 | 63 |
| 2016 December | 81 | 4 | 85 |
| 2016 November | 102 | 11 | 113 |
| 2016 October | 142 | 8 | 150 |
| 2016 September | 211 | 7 | 218 |
| 2016 August | 209 | 7 | 216 |
| 2016 July | 202 | 12 | 214 |
| 2016 June | 145 | 0 | 145 |
| 2016 May | 168 | 0 | 168 |
| 2016 April | 113 | 0 | 113 |
| 2016 March | 90 | 0 | 90 |
| 2016 February | 103 | 0 | 103 |
| 2016 January | 100 | 0 | 100 |
| 2015 December | 135 | 0 | 135 |
| 2015 November | 90 | 0 | 90 |
| 2015 October | 76 | 0 | 76 |
| 2015 September | 70 | 0 | 70 |
| 2015 August | 76 | 0 | 76 |
| 2015 July | 83 | 0 | 83 |
| 2015 June | 43 | 0 | 43 |
| 2015 May | 59 | 0 | 59 |
| 2015 April | 7 | 0 | 7 |
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