A 75 year-old man presented with shortness of breath and increased bilateral lower extremity edema for 3\r\nweeks. He was found to have nephrotic syndrome with a 24-hour urine protein excretion of 14 g. The serum creatinine\r\nhad increased to 2.0 mg/dL from a baseline of 1.0 mg/dL within one month. Based on the initial presentation with\r\nshortness of breath and tachycardia, the patient was empirically treated with intravenous heparin infusion for suspected\r\npulmonary embolism. The patient developed bleeding per rectum. Heparin was discontinued. A colonoscopy revealed\r\na 6 cm rectosigmoid mass with biopsy showing moderately differentiated adenocarcinoma. A renal biopsy showed\r\nnormal glomeruli on light microscopy and 100% foot process effacement on electron microscopy, consistent with\r\nminimal change disease (MCD). Treatment was initiated with prednisone 80 mg daily (1 mg/kg/d) and furosemide 40\r\nmg twice daily orally. The patient underwent surgery and adjuvant chemoradiation. Lower extremity edema improved\r\ngreatly over one month. Serum albumin increased to 2.6 g/dL Urine protein to creatinine ratio was 0.3. The serum\r\ncreatinine returned to 1.0 mg/dL at baseline. Prednisone had been gradually tapered to 5 mg/day.\r\nParaneoplastic glomerular disease is a rare manifestation of malignancy that is frequently mistaken from other\r\nglomerular diseases. In patients with nephrotic syndrome, especially elderly, the possibility of underlying malignancy\r\nshould be considered. Colorectal cancer-associated MCD is uncommon and has been reported in only 6 cases to\r\ndate. We present another case of rectal cancer-associated MCD with acute kidney injury and nephrotic syndrome.\r\nConsidering that MCD is more steroid responsive than other nephrotic diseases, early recognition and diagnosis may\r\nhelp to expedite effective therapy. Also, ablation of the tumor frequently results in remission of MCD
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