title: A case report of glomerulopathy-associated podocytic infolding in a patient with tumor lysis syndrome.
abstract: A 59-year-old man underwent total gastrectomy and splenectomy for gastric cancer 14 months before admission. The pathological diagnosis was neuroendocrine carcinoma of the stomach. Eight months after the operation, systemic chemotherapy with irinotecan and cisplatin was started because of multiple metastases to lymph nodes. After two courses of chemotherapy, renal function continued to decline. Renal biopsy showed acute tubular necrosis with cast formation, where needle crystallization was found. These clinicopathological findings suggested that tumor lysis syndrome was the cause of acute renal insufficiency. Moreover, diffuse, global bubbling and focal segmental spike formation were revealed by periodic acid-silver methenamine stain in the glomerular basement membrane. Electron microscopy showed an infolding of the cytoplasm of podocytes into the basal basement membrane and spotty electron-lucent areas. These ultrastructural findings, but not epimembranous deposits, corresponded with the bubbling on PAM staining. The present case was a rare case of glomerulopathy associated with podocytic infolding, which was not associated with collagen disease but with tumor lysis syndrome.
authors.affiliation: Department of Nephrology, Fuji City General Hospital, Shizuoka, Japan. ji2-k-y@mtj.biglobe.ne.jp
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Kensuke
authors.initials: K
authors.lastname: Joh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokote
authors.forename: Kenji
authors.initials: K
authors.lastname: Kasai
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hosoya
mesh_terms: D050533:Glomerular Basement Membrane / Q000473:pathology* / Q000648:ultrastructure; D015433:Glomerulonephritis, Membranous / Q000473:pathology*; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D050199:Podocytes / Q000473:pathology* / Q000648:ultrastructure; D015275:Tumor Lysis Syndrome / Q000473:pathology*