A rare case of minimal change disease associated with gastrointestinal stromal tumor (GIST) was presented in a report and published in BMC Nephrology.
The patient presented with nephrotic syndrome and proteinuria that was initially considered to be due to diabetic nephropathy based on a history of type 2 diabetes. A biopsy of the kidney revealed that the nephrotic syndrome was actually due to minimal change disease.
A space-occupying lesion in the duodenum was discovered on imaging examination. The lesion was confirmed to be GIST after surgical resection.
“[Minimal change disease] in this case may be caused by GIST, and it is speculated that some tumor factors secreted by GIST may cause the increased permeability of the glomerular basement membrane (GBM), then lead to proteinuria,” the authors said.
The patient also had a significant increase in immunoglobulin E (IgE) levels becoming as high as 8530 mg/dL. The levels decreased following the administration of imatinib mesylate and reduced slowly even further after resection surgery. Eight months after resection, the IgE levels had dropped to 1360 mg/dL.
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The authors suggested that the elevated IgE levels, GIST, and minimal change disease may all be correlated with one another with the GIST possibly being treated as a foreign antigen or allergen causing the release of IgE. It was also suggested that the IgE may contribute to proteinuria.
“In conclusion, for patients with elevated IgE level associated with nephrotic syndrome, the possibility of tumor must be taken into account when allergic factors are excluded,” the authors recommended.
The patient in the case report was a 66-year-old female with a history of diabetes and high blood pressure. She presented with edema of the eyelid and lower limbs lasting for 1 month prior to admission to the hospital. She also had increased foam in the urine, nausea, abdominal distension, and poor appetite.
After tests, she was diagnosed with minimal change disease and subacute tubulointerstitial injury and was discharged after remission following diuresis, antihypertensive treatment, blood glucose control, and anemia correction. She was readmitted a few months later with elevated IgE levels and proteinuria and the lesion was discovered. Treatment with imatinib mesylate and resection surgery resulted in a slow decline in proteinuria, and IgE levels.
Yu CY, Liu J, Qi CH, Wu ZY, Xiao YF, Zhang XG. Minimal change disease associated with gastrointestinal stromal tumor accompanied by significantly elevated serum IgE level: a case report. BMC Nephrol. 2022;23(1):139. doi:10.1186/s12882-022-02775-x