Minimal Change Disease as a Paraneoplastic Manifestation of Solid Malignant Tumors

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Solid malignant tumors are associated with a wide range of paraneoplastic manifestations including glomerular diseases. Membranous nephropathy is commonly associated with solid malignancies but minimal change disease (MCD) has predominantly been reported in association with Hodgkin's lymphoma. The association between MCD and solid malignant tumors has not previously been well described. All case reports and series in the English medical literature of patients with MCD and solid malignant tumors, including malignant thymoma, were systematically reviewed. Thirty-one patients with non-thymoma solid malignant tumors and 26 patients with malignant thymoma associated with MCD were identified. Nephrotic syndrome was present in 91% (52 of 57) of cases. Among those with malignant thymoma and MCD, 16 of 25 (64%) patients whose renal function were reported had impaired renal function, defined as serum creatinine over 120 mmol/L, at the time of presentation. In the solid malignancy group, 15 of 25 (60%) had renal impairment. In the malignant thymoma group, complete, partial or no remission of MCD was observed in 11, 5 and 8 cases, respectively, within the follow-up interval of each report. In the non-thymoma group, 12 of 31 went into complete remission and 10 were in partial remission. Nine cases showed no response to the treatment. There is an association between the activity of MCD and the malignancy status. Death was reported in 15 of 23 patients with solid non-thymoma malignancies and 6 of 13 with malignant thymoma. MCD is associated with solid malignant tumors infrequently as a paraneoplastic manifestation. The response of MCD to treatment and survival of this group of patients can be variable depending on the disease stage of the associated malignancy.