Poststreptococcal acute glomerulonephritis in a girl with renal cell carcinoma: possible pathophysiological association
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CASE REPORT
Poststreptococcal acute glomerulonephritis in a girl with renal cell carcinoma: possible pathophysiological association Asako Kageyama1 · Hiroko Fukushima1,2 · Joichi Usui3 · Atsushi Iwabuchi1,2 · Ryoko Suzuki1,2 · Kouji Masumoto4 · Takashi Oda5 · Michio Nagata6 · Hidetoshi Takada1,2 Received: 8 February 2020 / Accepted: 26 August 2020 © Japanese Society of Nephrology 2020
Abstract The severity of the poststreptococcal acute glomerulonephritis is considered to be modulated by the immune response of each individual, although there had been few reports regarding specific factors. Renal cell carcinoma is a cancer frequently associated with paraneoplastic syndrome, characterized by fever, leukocytosis, elevated cytokines, and elevated hormone levels. All of these symptoms resolve after tumor resection. A girl with renal cell carcinoma developed renal failure rapidly, which resolved promptly right after nephrectomy for the carcinoma. She was diagnosed as having poststreptococcal acute glomerulonephritis according to the results of pathological and serological examinations. In addition, elevated serum interleukin-6 level before the surgery was detected. Six and a half years after the diagnosis, the patient’s renal function was within normal range and she was tumor free. Because of the quick resolution of her renal dysfunction after the nephrectomy, paraneoplastic syndrome induced by renal cell carcinoma seemed to play a key role in the accentuation of poststreptococcal acute glomerulonephritis. Keywords Paraneoplastic syndrome · Poststreptococcal acute glomerulonephritis · Renal cell carcinoma
Introduction
* Hiroko Fukushima [email protected] 1
Department of Pediatrics, University of Tsukuba, 2‑1‑1 Amakubo, Tsukuba, Ibaraki 305‑8576, Japan
2
Department of Child Health, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
3
Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
4
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
5
Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji city, Tokyo 193‑0998, Japan
6
Department of Renal Pathology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
Various factors of immune responses affect the development of poststreptococcal acute glomerulonephritis (PSAGN). While immune complexes were reported to contribute partly to the development of nephritis, its pathogenesis has yet to be completely elucidated [1]. Only 5–10% of children with streptococcal pharyngitis develop PSAGN [2]. At present, predictive factors for PSAGN development after streptococcal infection are unavailable. Paraneoplastic syndrome with hypercytokinemia is known to develop in 10–40% of patients with renal cell carcinoma (RCC) [3]. Increase in serum inflammatory cytokine levels has been reported to be us
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