Nephrotic Syndrome Associated with Malignant Mesothelioma

Sumi Tanaka, MD, 2nd Department of Internal Medicine, Urafune Hospital, 3-46 Urafune-cho, Minami-ku, Yokohama 232 (Japan) Discharge Admission Total protein ‘Albumin November 1991 Dear Sir, The association between nephrotic syndrome and malignancy has been well documented [1-3]. Several types of glomerular injury have been noted in patients with cancer [2], and the neoplasms that have been implicated include a variety of histological types from different primary sites [3]. We present a case with nephrotic syndrome associated with malignant mesothelioma. A 77-year-old man was admitted to our hospital with systemic edema, generalized weakness, and fatigue. Two years previously he had a pneumonia, at which time urinalysis showed no protein. He had not been receiving any medications. He had been working as an engineer on a ship and had been exposed to asbestos approximately 40 years prior to admission. Physical examination: On auscultation of his lungs, there were decreased breath sounds and some moist rales on the left. Heart sounds and abdomen were normal, and there was no lymphadenopathy. There was pitting edema of the whole body. Laboratory values included the following: total serum protein 5.4 g/dl, serum albumin 1.3 g/dl, total serum bilirubin 0.2 mg/ dl, serum glutamic-oxaloacetic transaminase 32 IU/1, serum glutamic-pyruvic transaminase 22, alkaline phosphatase 556IU/1, blood urea nitrogen 14 mg/dl, serum creatinine 0.8 mg/dl, Na 130 mEq/1, K 3.7 mEq/1, Ca 6.4 mg/dl, P 2.8, serum glucose 141, total cholesterol 184, triglycerides 107 mg/dl, eryth-rocyte sedimentation rate 50 mm/h, hemoglobin 8.9 g/dl, hematocrit 27.4%, white blood cell count 11.1 × lOVμl (with an increase in