A case report of an association between membranoproliferative glomerulonephritis and metastatic colorectal carcinoma

Abstract

Background: Membranoproliferative glomerulonephritis is associated with monoclonal gammopathy but only rarely with solid organ tumours, mainly lung, renal, gastric, breast and prostate. There have been two reported cases of membranoproliferative glomerulonephritis associated with adenocarcinoma of the colon and rectum. Case Report: A 54-year-old male with a history of adenocarcinoma of the colon with metastasis to the liver and ureter presented with a one week history of bilateral pedal oedema, worsening hypertension and rise in serum creatinine from 111 μmol/L to 213μmol/L over two weeks. He had microscopic haematuria and proteinuria quantified at 24 grams/day. Serum albumin was 24 g/L compared with 35 g/L two weeks earlier. Other relevant investigations included negative hepatitis B and C serology, weakly positive speckled ANA titre of 160 (normal <40) with double stranded DNA of 0 IU/mL (normal <7), normal ratio serum free light chains, negative cryoglobulin screen, negative serum protein electrophoresis, and a normal C3 of 1.77 g/L and C4 of 0.38 g/L. Renal biopsy confirmed membranoproliferative glomerulonephritis Type I. Curative therapy for the malignancy was not possible, so treatment was commenced with prednisolone with consequential improvement in renal function and proteinuria, although serum albumin remained low. Conclusions: This case report illustrates an association between membranoproliferative glomerulonephritis with metastatic colorectal carcinoma, and elucidates some of the pathophysiological mechanisms underpinning this presentation. The case adds to the evidence to consider malignancy as an underlying pathology among newly diagnosed cases of nephrotic syndrome, whether that be due to membranous nephropathy or membranoproliferative glomerulonephritis. In the clinical setting, treatment of the underlying malignancy should be first considered in oncology patients presenting with renal failure which is suspected to be paraneoplastic in aetiology.<br />