Acute kidney injury associated with thymoma
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NEPHROLOGY - LETTER TO THE EDITOR
Acute kidney injury associated with thymoma Zi‑Shan Lin1 · Xi‑Zi Zheng1 · Ai‑Bo Qin1 · Su‑Xia Wang1,2 · Fu‑De Zhou1 · Ming‑Hui Zhao1,3 Received: 16 September 2020 / Accepted: 12 October 2020 © Springer Nature B.V. 2020
Editor, A 70-year-old man was admitted with a 2-month history of edema and subsequent oliguria. On admission, laboratory tests demonstrated anemia (hemoglobin, 79 g/L), nephrotic syndrome (urinary protein, 3.9 g daily; serum albumin, 2.1 g/dL) and acute kidney injury (serum creatinine, 6.2 mg/dL). Hypergammaglobulinemia was observed (IgG, 45.8 g/L; IgA, 9.0 g/L; IgM, 0.8 g/L; IgG4, 3.6 g/L). The result of serum immunofixation electrophoresis and the bone marrow smear were normal. Chest X-rays showed right-sided pleural effusion with pneumonia. A renal biopsy was performed (Fig. 1). Light microscopy revealed endocapillary proliferative glomerulonephritis with three cellular crescents and one fibro-cellular crescent in nine obtained glomeruli, which were surrounded by massive interstitial infiltration of monocytes, lymphocytes, and plasma cells. Immunofluorescence microscopy showed that the interstitial infiltrating cells were positive for CD138 (+ + +), and the IgG4 + plasma cell count was > 10/HPF. An anterior mediastinal mass measuring 3 × 2 cm was observed when a chest CT scan was performed to evaluate the severity
Zi-Shan Lin and Xi-Zi Zheng have contributed equally. * Fu‑De Zhou [email protected] 1
Renal Division, Department of Medicine, Peking University First Hospital, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune‑Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, People’s Republic of China
2
Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing 100034, People’s Republic of China
3
Peking-Tsinghua Center for Life Sciences, Beijing 100034, People’s Republic of China
of pneumonia (Fig. 2a). Noninvasive lymphocyte-rich thymoma (World Health Organization type B3) was confirmed by CT-guided percutaneous puncture biopsy (Fig. 2b–f). PET-CT showed large lymph nodes in multiple locations that were suggestive of metastasis. Thus, a diagnosis of endocapillary proliferative glomerulonephritis with crescents combined with IgG4-dominant tubulointerstitial nephritis associated with thymoma was made. Hemodialysis was initiated and plasmapheresis was performed five times due to hypergammaglobulinemia. Oral prednisolone (45 mg/day) and cyclophosphamide (50 mg/ day) were commenced. Thymectomy and chemotherapy could not be performed because of the patient’s poor condition. Thus, radiotherapy was administered. One month later, the patient’s urine volume had increased from 200 to 1500 ml per day. IgG and IgA levels had decreased to normal. Nevertheless, the patient rema
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