SHM Converge Scientific Abstract ePoster Gallery-Nephrotic Syndrome as the Initial Presentation of Gallbladder Adenocarcinoma

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This case report highlights nephrotic syndrome as the initial presentation of an underlying gallbladder adenocarcinoma. Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, peripheral edema, hyperlipidemia, and a hypercoagulable state. Because glomerular disease is a major cause of kidney failure, it should be considered in patients with unexplained edema, dyspnea, or urinary abnormalities.<br /><br />A 65-year-old man with hypertension developed six months of leg swelling, foamy urine, fatigue, dyspnea on exertion, weight loss, and rash. Laboratory testing showed hypoalbuminemia, elevated inflammatory markers, and a urine protein-to-creatinine ratio of 3882. He was referred to nephrology for a planned renal biopsy. Before the biopsy, he was hospitalized with worsening edema, shortness of breath, and right upper quadrant pain. Admission labs showed preserved kidney function but worsening hypoalbuminemia and cholestatic liver injury. Abdominal ultrasound suggested acute cholecystitis with a distended, thickened gallbladder containing stones and sludge. Serologic workup for secondary kidney disease was negative, including ANA, ANCA, RF, PLA2R, HIV, HBV, and HCV.<br /><br />He underwent cholecystectomy, and pathology revealed poorly differentiated gallbladder carcinoma. Because of his clinical instability and strong suspicion for malignancy-associated secondary membranous nephropathy, the renal biopsy was ultimately not performed.<br /><br />The report emphasizes the differential diagnosis of nephrotic syndrome and the distinction between primary and secondary membranous nephropathy. Primary membranous nephropathy is most often PLA2R antibody positive, while secondary causes include infections, autoimmune disease such as lupus, medications like NSAIDs and lithium, and malignancy. This case underscores the importance of evaluating for occult cancer in adults with nephrotic syndrome, especially when constitutional symptoms are present.

Asset Subtitle

Megan d'Andrea

Meta Tag

Author List Megan d'Andrea, Rex Hermansen, Sophie Sohval

Category Clinical Vignettes

Concept Nephrotic Syndrome

Concept Membranous Nephropathy

Concept Proteinuria

Concept Hypoalbuminemia

Concept Glomerular Disease

Distinguished Non-Finalist

Presenter Organization Mount Sinai Hospital

Presenting Author Megan d'Andrea

Track Adult

Keywords

nephrotic syndrome

gallbladder adenocarcinoma

membranous nephropathy

proteinuria

hypoalbuminemia

edema

malignancy-associated nephropathy

acute cholecystitis

renal biopsy

occult cancer

Nephrotic Syndrome

Membranous Nephropathy

Proteinuria

Hypoalbuminemia

Glomerular Disease