Renal involvement in a large cohort of Chinese patients with Castleman disease

Xu, Dianqing; Lv, Jicheng; Dong, Yujun; Su, Tao; Zhou, Fu-de; Zou, Wan-zhong; Zhao, Ming‐Hui; Zhang, Hong

doi:10.1093/ndt/gfr245

Cited by 56 publications

(59 citation statements)

References 15 publications

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“…Based on comparable clinical and laboratory chemical findings, some investigators considered that CSP is a variant of multicentric Castleman disease, known as angiofollicular lymph node hyperplasia [4]. Castleman disease is often accompanied by various renal lesions, including amyloidosis, thrombotic microangiopathy, and some forms of glomerulonephritis [5,6]. However, CSP is rarely accompanied by renal lesions [3].…”

Section: Introductionmentioning

confidence: 99%

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis

et al. 2017

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Cutaneous and systemic plasmacytosis (CSP) is a rare lymphoproliferative disorder that mainly affects middle-aged Asian individuals. Although Castleman disease is often complicated with various renal involvements, glomerulonephritis associated with CSP, which is considered as a variant of Castleman disease, is rare. This report presents the case of a 41-year-old Japanese man with nephrotic syndrome associated with CSP. Renal biopsy findings showed focal segmental glomerulosclerosis (FSGS) and diffusely mild segmental mesangial proliferation. Plasma cell infiltration in the interstitium was not observed. Electron microscopic findings showed diffuse foot process effacement, localized involvement of subendothelial space widening with amorphous materials, and endothelial cell swelling. Lymph node biopsy findings denied Castleman disease. His skin regions and proteinuria were successfully treated with prednisolone and cyclosporine. The causal relationship between CSP and FSGS is unknown. However, increased serum levels of IL-6 and VEGF and decreased VEGF expression in the podocyte may contribute to renal lesions in patients with CSP. To our best knowledge, this is the first case of a patient with FSGS associated with CSP.

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Section: Introductionmentioning

confidence: 99%

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis

et al. 2017

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“…In most previous case reports, the common etiology of renal failure due to CD reported is amyloidosis [13][14][15]. Morita-Hoshino et al reported that autopsy showed the deposition of AA amyloid in multiple organs such as kidney, liver, spleen, and gastrointestinal tract [15].…”

Section: Discussionmentioning

confidence: 99%

“…But in our case, gastric biopsy did not show the deposition of amyloid. Two cohort studies have described renal histopathology in CD patients, reporting thrombotic microangiopathy (TMA)-like lesions as the most common [13,14]. Other than that, CD patients show membranous proliferative glomerulonephritis (MPGN), crescentic glomerulonephritis, or interstitial nephritis [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Two cohort studies have described renal histopathology in CD patients, reporting thrombotic microangiopathy (TMA)-like lesions as the most common [13,14]. Other than that, CD patients show membranous proliferative glomerulonephritis (MPGN), crescentic glomerulonephritis, or interstitial nephritis [13,14]. Damin et al suggested that VEGF is likely involved in renal insufficiency, considering that small-vessel lesions (TMA-like lesions or MPGN) are common in CD patients [14].…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment by tocilizumab without steroid in a very severe case of TAFRO syndrome

et al. 2017

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A 59-year-old Japanese man was admitted to our hospital with leg edema, fatigue and fever. He had a past medical history of duodenal ulcer, fatty liver, hyperuricemia and positive rheumatoid factor, but was not receiving any medication. His son had died 2 years prior to this admission after following a clinical course that suggested TAFRO syndrome.The patient showed mild fever (about 37-38 °C), polypnea and severe leg edema on admission. Chest examination revealed decreased breath sounds in the right lung. No superficial lymph nodes were palpable. Laboratory tests on admission revealed mild thrombocytopenia, hypoproteinemia, elevation of C-reactive protein (CRP), alkaline phosphatase (ALP), creatinine (Cr), and urine N-acetyl-β-d-glucosaminidase (NAG) ( Table 1). Urine testing showed granular casts without proteinuria or hematuria. Concentrations of aspartate aminotransferase (AST) and alanine transaminase (ALT) were elevated, but unchanged compared with the results of a medical check 6 months before admission, and so were attributed to fatty liver. Chest X-ray and computed tomography (CT) showed mild lymphadenopathy in the mediastinum, bilateral pleural effusion and ascites (Fig. 1).Blood, sputum and urine culture tests were all negative and no other infectious diseases were present. Negative results were obtained for all autoantibodies. Among the tumor markers, only soluble interleukin-2 receptor (sIL-2R) was elevated. Bone marrow biopsy was performed to rule out malignant lymphoma, revealing normocellular Abstract Successful use of tocilizumab (TCZ) to treat TAFRO syndrome has recently been reported. In those cases, TCZ was used with steroid. We present herein the case of a 59-year-old man with very severe TAFRO syndrome who was successfully treated using TCZ without steroid. He showed rapidly progressive anasarca, acute renal failure and very severe thrombocytopenia. We initially used steroid, but its efficacy was limited. Moreover, steroid use had to be stopped as soon as possible, because hemorrhagic shock developed due to severe duodenal ulcer. After overcoming infections (about 40 days after stopping steroid), administration of TCZ was started and the patient was discharged in clinical remission.

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“…We also reviewed two large cohorts of renal involvement in CD (each had 19 cases). In some cases MPGN-like lesion was included in TMA (13). In other cases, both MPGN-like lesions and TMA were included in small vessel lesions (SVL) (14).…”

Section: Discussionmentioning

confidence: 99%

Membranoproliferative Glomerulonephritis in Castleman's Disease: A Systematic Review of the Literature and 2 Case Reports

Zhang

Wang

et al. 2012

Intern. Med.

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Renal involvement in a large cohort of Chinese patients with Castleman disease

Abstract: CD with multicentric type and PC or mixed cellularity variant are often associated with renal complications. Thrombotic microangiopathy-like lesions are the most common pathological characteristics. Chemotherapy can reverse kidney damage in most cases.

Cited by 56 publications

References 15 publications

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis

Successful treatment by tocilizumab without steroid in a very severe case of TAFRO syndrome

Membranoproliferative Glomerulonephritis in Castleman's Disease: A Systematic Review of the Literature and 2 Case Reports

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