Renal complications of Castleman’s disease: report of two cases and analysis of 75 cases

Abstract

Biopsy-proven renal complications of Castleman's disease (CD) are rare and current knowledge is largely based on sporadic case reports. We reported two more cases, both of which were multicentric CD with hyaline-vascular pathological pattern and presented with chronic renal failure. Case 1 was multicentric CD with renal mesangial proliferative glomerulonephritis complications, and case 2 was multicentric CD with membranoproliferative glomerulonephritis-like complications. Although both were eventually administered corticosteroids combined with cytotoxic drugs, both behaved in an aggressive and relapsing manner. We then made an analysis of 75 cases of biopsy-proven renal complications of CD (including our two cases) which were reported in 51 English literatures from January 1954 to March 2011. We found that the clinical and histological findings of renal complications of CD were heterogeneous. Death was observed in 17% patients after a median follow-up time of 22 months (0-204 months) since histological diagnosis of renal complications. The estimated 5-year cumulative survival rate was 75%. Better understanding and therapeutic interventions are required in further investigations.

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis

“…Castleman disease has sometimes been reported to have renal complications. The analysis of renal histology in 75 cases of Castleman disease revealed that a large number of patients had renal amyloidosis (26 cases, 35%), and a small subset had FSGS (5 cases, 7%) [13]. The causal relationship between FSGS and Castleman disease was also unknown, but IL-6 and VEGF, which may play a pathophysiological role in CSP and/or Castleman disease, might contribute to renal lesions.…”

A Case of Retroperitoneal Castleman’s Disease and an Update on the Latest Evidence

“…Between 11 per cent and 30 per cent of patients with POEMS syndrome have multicentric CD, most commonly the HHV-8-positive variant [ 7 ]. Contrary to the HV variant, the PC subtype often shows a clinically aggressive and relapsing course [ 15 ].…”

HHV-8-negative multicentric Castleman disease presenting as a crescentic immune complexes membranoproliferative glomerulonephritis

“…Up to 54% of multisystemic Castleman disease, mostly in plasma cell or mixed cellular type, are associated with nephropathy, defined as haematuria, proteinuria or renal insufficiency 11–14. The two main histological patterns are thrombotic microangiopathy (60%) and amyloidosis (20%) 15 16.…”