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| 조기위암과 연관된 막증식성사구체신염 1예 |
| 이재성 , 송경일 , 차미경 , 김정호 , 박민선 , 진소영 , 한동철 , 이상구 , 황승덕 , 이희발 |
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| Abstract |
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The occurrence of nephrotic syndrome in associ- ation with neoplasia has been well documented in the literature. It is important to note that the occ- urrence of the nephrotic syndrome in patients over 45 years of age rnay be associated with occult malignancy. The nephrotic syndrorne may be the presenting sign of an otherwise occult neoplasm and older patients with idiopathic membranous nephro- pathy in particular, should be carefully evaluated for malignancy. We report a case of early gastric adenocarcinoma presenting as nephrotic syndrome due to membrano- proliferative glomeruonephritis. After surgical resec- tion, the proteinuria is remitted completely. The lesion most frequently found in patients with nephrotic syndrome associated with the internal malignancy is membranous nephropathy, which led to speculation that the lesion is irnmunologically mediated. Alth- ough our patient demonstrated a mernbranoproli- ferative glomerulopathy histologically, this is not in- consistent with such an association. Circumstantial evidence favoring an immune me- chanism includes remission of the nephrotic syn- drome with treatment of the tumor, relapse of renal disease with recurrence of the lymphoma or mali- gnancy and a temporal association between the dia- gnosis of a glomerulopathy and malignancy. The proposed pathogenesis of glomerular lesion in this setting includes circulating immune complex formed by specific tumor antigen. In our patient the neph- rotic syndrome resolved after surgical removal of the tumor thus suggesting the causal relationship bet- ween cancer and the renal lesions. |
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