A Case of Castleman’s Disease during the Long-Term Course of Membranous Nephropathy

Figure 1

Clinical course of the patient. The patient was referred to a nephrologist with a diagnosis of nephrotic syndrome at 76 years of age. The serum level of immunoglobulins was high in addition to massive urinary protein, and polyclonal gammopathy was identified. Before administration of prednisolone for the treatment of nephrotic syndrome, inguinal lymph node biopsy was performed. Nephrotic syndrome promptly responded to prednisolone and proteinuria improved along with decreased disease markers of Castleman’s disease, such as IgG, IgA, C-reactive protein, serum IL-6, and plasma VEGF. During tapering of prednisolone, proteinuria transiently elevated. We performed renal biopsy to evaluate activity of renal involvement for decision making regarding long-term treatment. LN, lymph node; Ig, immunoglobulin; IL-6, interleukin-6; and VEGF, vascular endothelial growth factor.