title: A case of membranous glomerulonephritis associated with gastric cancer.
abstract: We describe a patient with gastric cancer and membranous glomerulonephritis (MGN). The patient, a 61-year-old male, was admitted to our Hospital in May, 1996, because of proteinuria and hyperlipidemia persisting for a year. Laboratory examination filled the criteria of nephrotic syndrome and renal biopsy revealed MGN of stage II. Prednisolone therapy (40 mg/day p.o.) was started, followed by a gradual decrease in proteinuria from 4.5 g/day to 0.1 g/day. Endoscopic examination was performed because of stomach-ache revealed advanced gastric cancer of Borrmann 4. Desiring for a conservative therapy, he was discharged and moved to a hospice. In literature review, MGN is the most frequent lesion among various glomerular diseases associated with malignancy, such as the lung, stomach, and colon, particularly at an elderly ages, and sometimes antedates the detection of malignancy, as in the present case. In several cases with MGN, immune-complexes composed of tumor antigens, such as carcino-embryonic antigen, and antibodies have been reported to deposit in basement membrane of glomeruli, causing MGN. In the renal and gastric cancer tissues of the present case, the presence of three novel tumor-associated antigens, Span-1, Thomsen-Friedenreich antigen (T antigen) and F1 alpha antigen, was examined, using a immuno-peroxidase method. Although none of these three antigens were immuno-stained in the renal tissue, clinical course and literature review suggest that MGN in this patient seems to be associated with gastric cancer, which may have produced MGN-causing tumor antigens other than the three antigens. It should be emphasized that malignancy should be carefully and routinely examined in patients with MGN, particularly at elderly ages.
authors.affiliation: Second Department of Internal Medicine, Osaka City University Medical School, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Waki
authors.forename: E
authors.initials: E
authors.lastname: Ishimura
authors.forename: H
authors.initials: H
authors.lastname: Morii
authors.forename: S
authors.initials: S
authors.lastname: Sakai
authors.forename: S
authors.initials: S
authors.lastname: Saitoh
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: M
authors.initials: M
authors.lastname: Matsuyoshi
authors.forename: S
authors.initials: S
authors.lastname: Wada
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authors.initials: H
authors.lastname: Tsukuda
authors.forename: M
authors.initials: M
authors.lastname: Emoto
authors.forename: A
authors.initials: A
authors.lastname: Shioi
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authors.initials: Y
authors.lastname: Nishizawa
authors.forename: K
authors.initials: K
authors.lastname: Goto
authors.forename: M
authors.initials: M
authors.lastname: Sakurai
authors.forename: K
authors.initials: K
authors.lastname: Wakasa
authors.forename: Y
authors.initials: Y
authors.lastname: Yamashita
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chung
authors.forename: M
authors.initials: M
authors.lastname: Sowa
mesh_terms: D015433:Glomerulonephritis, Membranous / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology; D013274:Stomach Neoplasms / Q000150:complications*