A Case of Colon Cancer-Associated Membranous Glomerulopathy

Case History

A 62-year-old black man was hospitalized with dyspnea on exertion. Clinical records revealed a history of pedal edema, new-onset hyperlipidemia, hypoalbuminemia, and uncontrolled hypertension. Renal and liver function tests were within normal limits. An echocardiogram performed 2 years earlier had revealed no cardiac dysfunction. Prior to admission, his primary caregiver had unsuccessfully attempted to manage his symptoms with diuretic therapy.

Blood pressure on admission was 154/91 mm Hg, pulse 89 beats/min, and temperature 36.7° C. The patient was in mild respiratory distress. Cardiopulmonary exam was unremarkable with the exception of bilateral crackles that were much greater on the left lung base than the right. Significant pitting edema was present in the lower extremities, scrotum, and sacrum. His abdomen was nontender and without appreciable hepatomegaly or mass. Hematochezia was appreciated without visible external hemorrhoids or anal tenderness by rectal exam. There was no clubbing or peripheral neuropathy.

Laboratory examination included a normal hematocrit, white blood cell count, and differential, with the exception of a mean corpuscular volume of 71 fL. Renal and liver function panels remained within normal limits, with a serum BUN of 12 mg/dL and creatinine of 1.0 mg/dL, but a total protein concentration of 5.6 g/dL and albumin concentration of 2.2 g/dL. A lipid panel showed a total cholesterol of 470 mg/dL. Urinalysis revealed 4+ proteinuria and < 3 red blood cells, with occasional granular casts per high-power field. Urine protein excretion was found to be 8-9 g/day by spot and 24-hour urine protein collection. Chest radiography confirmed bilateral pleural effusion, left greater than right. Renal ultrasound found bilaterally equal and normal-size kidneys without significant increase in restrictive indices, hydroureter, or stones.

What is the differential diagnosis for this patient?

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Cite this: A Case of Colon Cancer-Associated Membranous Glomerulopathy - Medscape - Mar 13, 2009.