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Sipahioglu, Veli Berk, Bulent Tokgoz, Oktay Oymak" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Ismail" "apellidos" => "Kocyigit" "email" => array:1 [ 0 => "iikocyigit@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Sumeyra" "apellidos" => "Dortdudak" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "Eray" "apellidos" => "Eroglu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:3 [ "nombre" => "Aydin" "apellidos" => "Unal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Murat H." "apellidos" => "Sipahioglu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Veli" "apellidos" => "Berk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 6 => array:3 [ "nombre" => "Bulent" "apellidos" => "Tokgoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 7 => array:3 [ "nombre" => "Oktay" "apellidos" => "Oymak" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Department of Oncology, Erciyes University Medical School, Kayseri, Turkey, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Immunoglobulin A nephropathy could be a clue for the recurrence of gastric adenocarcinoma" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor,</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The association of nephrotic syndrome that was presented with IgA nephropathy (IgA-N) and malignancy has been previously reported.</p><p class="elsevierStylePara">IgA –N was first described by Berger and Hinglais in 1968. It is now generally known to be the most common cause of primary glomerulonephritis worldwide and is characterized by mesangial proliferation and deposition of IgA.<span class="elsevierStyleSup">1</span> Malignancies that have been reported to be associated with IgA-N include Hodgkin’s disease,<span class="elsevierStyleSup">2</span> and non-Hodgkin lymphoma<span class="elsevierStyleSup">3</span> renal cell carcinoma,<span class="elsevierStyleSup">4</span> cancers of the lung,<span class="elsevierStyleSup">5</span> larynx and esophagus.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">We report a case of IgA-N presented with the recurrence of gastric adenocarcinoma in a 58 year-old patient.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE REPORT</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">A 58 year-old man admitted to our hospital in September 2010 with distension of the abdomen and involuntary loss of his %10 weight in the last three months. There were no abnormalities in urine examination on the first evaluation. Upper gastrointestinal endoscopy showed gastric mass and endoscopic biopsy revealed gastric adenocarcinoma. Since diagnosed with stage 3B gastric adenocarcinoma, the chemoradiotherapy (4 cycles of 5-fluorouracil and folinic acid with 50 Gy radiotherapy) was administered after the surgery. Complete remission was achieved and he has been considered for follow-up with three months interval without chemotherapy. He was admitted to our hospital with dyspnea and edema in January 2012. Hypoalbuminemia and 4 gram proteinuria was revelaed in laboratory examination. PET-CT scan was showed pleural effusion, bone metastasis and recurrence in mediastinal and abdominal lymph nodes. Then he was considered recurrence of the disease and reevaluated as stage 4 gastric adenocarcinoma. According to his performance status, chemotherapy was not considered and he was referred to our nephrology department for nephrotic syndrome. His blood pressure, temperature and pulse rate were normal. Physical examination revealed decreased breath sound over the right and left lower lung areas and severe edema in both lower extremities. Routine laboratory tests showed the following: serum levels of sodium 137mmol/L, potassium: 5.8mmol/L, calcium: 7.6mg/dL and phosphate: 2.9mg/dL. Blood urea nitrogen (BUN) 22mg/dL, serum creatinine 1.5mg/dL, serum albumin 1.4g/dL and hemoglobin 11.8g/dL. Liver function parameters were within their normal limits. Urinalysis showed urine red blood cells (RBC) counts were >100/high power field, and urinary protein excretion was 3.5g/day. Antinuclear antibody, anti-DNA, anti-streptolysin O, anti-neutrophil cytoplasmic antibody, anti-glomerular basement membrane antibody, anti-HBs, and anti-HCV were all negative. Complement factors C3 and C4 were within normal ranges. Serum and urine protein electrophoresis were negative for monoclonal gammopathy. The peripheral blood smear was normal with no schistocytes.</p><p class="elsevierStylePara">Renal biopsy was performed and in total 14 glomeruli were obtained and evaluated. Light microscopy showed that one of the glomeruli had global sclerosis and other glomeruli had mesangial proliferation<span class="elsevierStyleItalic">. </span>Immunohistochemically, focal segmental mesangial IgA deposition was seen in three glomeruli (Figure 1). Steroid therapy with 1mg/kg/day metilprednisolone and losartan 50mg/daily were started and steroid dose was reduced gradually. After six months later, edema was completely regressed and serum albumin level was 3.0dL. Additionally, urinalysis showed only 1-2 RBC and proteinuria was 0.2g/day (Table 1).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Malignancy associated nephrotic syndrome has been described in the literature by Lee et al. reported that nephrotic syndrome occurring simultaneously with malignancy was 10 times higher than in the general population.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">Paraneoplastic syndrome may be suspected in the presence of the following criteria: (a) no evident etiology for the associated syndrome; (b) the diagnosis of the syndrome and cancer simultaneously; (c) clinical (and histological) remission after full remission achieved by chemotherapy or complete surgical removal of the tumor; (d) increases of associated symptoms with tumor recurrence.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Different types of glomerulopathies, generally membranous glomerulonephritis have been associated with solid tumors.<span class="elsevierStyleSup">8</span> However paraneoplastic IgA-N has been reported rarely.</p><p class="elsevierStylePara">Primarily, IgA-N associations with cancer of the buccal cavity, the nasopharynx and the respiratory tract have been described. Mesangial IgA deposits have been found at autopsy in patients who died of a gastro-intestinal neoplasia without prior clinical evidence of nephropathy.<span class="elsevierStyleSup">9</span> Despite intensive investigation, the mechanism underlying glomerular IgA deposition in IgA nephropathy has not been clarified.<span class="elsevierStyleSup">10</span> There are two isotype subclasses of IgA: IgA1 and IgA2. Gastrointestinal and respiratory tracts plasma cells produce both IgA1 and IgA2; however plasma cells in the spleen, lymph nodes and bone marrow produce predominantly IgA1. Invasion of the intestinal mucosa by malignancy increases the circulating IgA level and therefore leads to the formation of mesangial deposits.<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">In conclusion, paraneoplastic IgA nephropathy with nephrotic syndrome could be a clinical problem in patients with malignancies, besides the treatment chart has not been well-decumented yet. To the best of our knowledge, we report the first case of paraneoplastic IgA-N associated with recurrence of gastric adenocarcinoma. IgA-N should take into account in patients with malignancy and nephrotic syndrome even if primary disease was on remission and it could be a harbinger for the relapse of disease.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12266_16025_50533_en_t1122662.jpg" class="elsevierStyleCrossRefs"><img src="12266_16025_50533_en_t1122662.jpg" alt="Change in serum albumin, creatinine and proteinuria levels after treatment at different times"></img></a></p><p class="elsevierStylePara">Table 1. Change in serum albumin, creatinine and proteinuria levels after treatment at different times</p><p class="elsevierStylePara"><a href="grande/12266_16025_50534_en_f112266.jpg" class="elsevierStyleCrossRefs"><img src="12266_16025_50534_en_f112266.jpg" alt="Focal segmental mesangial IgA deposition in three glomeruli."></img></a></p><p class="elsevierStylePara">Figure 1. Focal segmental mesangial IgA deposition in three glomeruli.</p>" "pdfFichero" => "P1-E562-S4417-A12266.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec433622" "palabras" => array:1 [ 0 => "Immunoglobulin A nephropathy" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec433624" "palabras" => array:1 [ 0 => "Malignancy" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec433626" "palabras" => array:1 [ 0 => "Paraneoplastic syndrome" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Donadio JV, Grande JP. IgA nephropathy. N Engl J Med 2002;5:738-48." 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 5 | 7 | 12 |
2024 Octubre | 45 | 39 | 84 |
2024 Septiembre | 48 | 18 | 66 |
2024 Agosto | 62 | 53 | 115 |
2024 Julio | 43 | 28 | 71 |
2024 Junio | 51 | 35 | 86 |
2024 Mayo | 70 | 31 | 101 |
2024 Abril | 41 | 37 | 78 |
2024 Marzo | 36 | 27 | 63 |
2024 Febrero | 33 | 40 | 73 |
2024 Enero | 33 | 23 | 56 |
2023 Diciembre | 38 | 21 | 59 |
2023 Noviembre | 51 | 35 | 86 |
2023 Octubre | 70 | 35 | 105 |
2023 Septiembre | 75 | 33 | 108 |
2023 Agosto | 60 | 24 | 84 |
2023 Julio | 45 | 40 | 85 |
2023 Junio | 80 | 26 | 106 |
2023 Mayo | 66 | 35 | 101 |
2023 Abril | 72 | 27 | 99 |
2023 Marzo | 70 | 25 | 95 |
2023 Febrero | 64 | 27 | 91 |
2023 Enero | 25 | 26 | 51 |
2022 Diciembre | 50 | 36 | 86 |
2022 Noviembre | 35 | 43 | 78 |
2022 Octubre | 55 | 47 | 102 |
2022 Septiembre | 49 | 31 | 80 |
2022 Agosto | 48 | 42 | 90 |
2022 Julio | 45 | 46 | 91 |
2022 Junio | 44 | 52 | 96 |
2022 Mayo | 80 | 37 | 117 |
2022 Abril | 55 | 56 | 111 |
2022 Marzo | 68 | 48 | 116 |
2022 Febrero | 87 | 53 | 140 |
2022 Enero | 88 | 36 | 124 |
2021 Diciembre | 45 | 40 | 85 |
2021 Noviembre | 51 | 37 | 88 |
2021 Octubre | 63 | 55 | 118 |
2021 Septiembre | 55 | 30 | 85 |
2021 Agosto | 50 | 43 | 93 |
2021 Julio | 53 | 40 | 93 |
2021 Junio | 41 | 24 | 65 |
2021 Mayo | 45 | 39 | 84 |
2021 Abril | 87 | 93 | 180 |
2021 Marzo | 56 | 44 | 100 |
2021 Febrero | 55 | 19 | 74 |
2021 Enero | 56 | 26 | 82 |
2020 Diciembre | 40 | 9 | 49 |
2020 Noviembre | 29 | 19 | 48 |
2020 Octubre | 33 | 20 | 53 |
2020 Septiembre | 33 | 13 | 46 |
2020 Agosto | 36 | 10 | 46 |
2020 Julio | 49 | 10 | 59 |
2020 Junio | 54 | 25 | 79 |
2020 Mayo | 48 | 11 | 59 |
2020 Abril | 44 | 16 | 60 |
2020 Marzo | 46 | 22 | 68 |
2020 Febrero | 86 | 20 | 106 |
2020 Enero | 75 | 31 | 106 |
2019 Diciembre | 91 | 37 | 128 |
2019 Noviembre | 60 | 27 | 87 |
2019 Octubre | 50 | 19 | 69 |
2019 Septiembre | 65 | 26 | 91 |
2019 Agosto | 45 | 32 | 77 |
2019 Julio | 44 | 23 | 67 |
2019 Junio | 49 | 24 | 73 |
2019 Mayo | 50 | 26 | 76 |
2019 Abril | 93 | 46 | 139 |
2019 Marzo | 45 | 20 | 65 |
2019 Febrero | 36 | 13 | 49 |
2019 Enero | 44 | 31 | 75 |
2018 Diciembre | 123 | 42 | 165 |
2018 Noviembre | 205 | 18 | 223 |
2018 Octubre | 136 | 30 | 166 |
2018 Septiembre | 82 | 13 | 95 |
2018 Agosto | 77 | 22 | 99 |
2018 Julio | 59 | 16 | 75 |
2018 Junio | 50 | 13 | 63 |
2018 Mayo | 63 | 7 | 70 |
2018 Abril | 67 | 21 | 88 |
2018 Marzo | 61 | 12 | 73 |
2018 Febrero | 44 | 8 | 52 |
2018 Enero | 43 | 12 | 55 |
2017 Diciembre | 58 | 9 | 67 |
2017 Noviembre | 57 | 8 | 65 |
2017 Octubre | 43 | 10 | 53 |
2017 Septiembre | 58 | 9 | 67 |
2017 Agosto | 69 | 15 | 84 |
2017 Julio | 71 | 12 | 83 |
2017 Junio | 63 | 15 | 78 |
2017 Mayo | 63 | 11 | 74 |
2017 Abril | 42 | 16 | 58 |
2017 Marzo | 36 | 16 | 52 |
2017 Febrero | 29 | 7 | 36 |
2017 Enero | 50 | 3 | 53 |
2016 Diciembre | 97 | 7 | 104 |
2016 Noviembre | 96 | 15 | 111 |
2016 Octubre | 160 | 15 | 175 |
2016 Septiembre | 169 | 2 | 171 |
2016 Agosto | 288 | 9 | 297 |
2016 Julio | 205 | 13 | 218 |
2016 Junio | 150 | 0 | 150 |
2016 Mayo | 153 | 0 | 153 |
2016 Abril | 135 | 0 | 135 |
2016 Marzo | 125 | 0 | 125 |
2016 Febrero | 140 | 0 | 140 |
2016 Enero | 131 | 0 | 131 |
2015 Diciembre | 168 | 0 | 168 |
2015 Noviembre | 122 | 0 | 122 |
2015 Octubre | 116 | 0 | 116 |
2015 Septiembre | 110 | 0 | 110 |
2015 Agosto | 108 | 0 | 108 |
2015 Julio | 119 | 0 | 119 |
2015 Junio | 80 | 0 | 80 |
2015 Mayo | 115 | 0 | 115 |
2015 Abril | 27 | 0 | 27 |