Remission of Membranous Nephropathy after Treatment of Localised Prostate Cancer

Membranous nephropathy is a cause of the nephrotic syndrome in adults; it can be a primary or secondary process. Secondary causes include solid organ and lymphoid malignancies. Prostate cancer has been reported as the second most common causative malignancy. Remission of membranous nephropathy following treatment of metastatic prostate cancer is well established. In this case, we describe a patient with localised prostate cancer who developed severe nephrotic syndrome (urine protein creatinine ratio 1,616 mg/mmol and serum albumin 17 g/L) secondary to membranous nephropathy. The prostate cancer was deemed of low risk and so was being managed with active surveillance rather than medical treatment. Given the severity of the nephrotic syndrome a trial of androgen deprivation therapy with bicalutamide was agreed between the nephrology and urology teams. Full remission of the nephrotic syndrome was observed within 6 months of commencement of treatment (normalisation of serum albumin, non-nephrotic range urine protein creatinine ratio and resolution of oedema). The bicalutamide has been continued indefinitely.