Abstract
STEROID RESISTANT MINIMAL CHANGE DISEASE ASSOCIATED WITH THYMOMA: A CASE REPORT Rakesh Lattupalli, Quresh Khairullah, Keith Bellovich, Joel Topf. Division of Nephrology, St John Hospital and Medical center, Detroit, Mi, USA Background: The association of glomerulonephritis and thymic tumor was first described by Posner et al in 1980 . The association is quite low; <1% in surgical series. A total of 21 cases have been reported in the French and English literature. Minimal change disease (MCD) is the most frequent (67%) thymoma associated glomerular lesion. Fortunately the majority (84%) of these patients are steroid sensitive. We report a case of steroid resistant thymoma associated MCD. Case Report: A 63-year-old male with past medical history of diabetes mellitus for six years was referred for new onset nephrotic syndrome. Kidney biopsy revealed MCD. The proteinuria did not respond to steroids. Further diagnostic tests revealed a mediastinal mass. Following removal this was diagnosed as spindle cell thymoma. Post thymectomy hypoalbuminemia persisted despite modest reduction in proteinuria. The patient continued to have edema resistant to diuretic therapy and eventually was started on dialysis. Discussion: The pathogenesis of glomerular lesions in thymoma related minimal change disease remains controversial. The beneficial effect of immunosuppressive therapy in most patients suggests a link between the immune system and MCD. Animal studies suggest that thymectomy does not modify the nephropathy. Further studies of this association between nephrotic syndrome and thymoma are needed to define the specific immune dysregulation associated with this disorder.
Published Version
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