Crescentic glomerulonephritis associated with prostatic carcinoma: evidence of immune-mediated glomerular injury

The glomerulus, a small structure in the kidney composed of blood vessels, functions to filter blood during the formation of urine. Glomerular disease is rarely associated with cancer of the prostate, a gland in males that secretes fluid into semen. A case is described of an 81-year-old man with metastatic or widespread prostatic cancer, who developed kidney failure and nephrotic syndrome, or disease of the glomerular blood vessels as a result of glomerulonephritis, or inflammation of the kidney originating in the glomeruli. Impaired kidney function and nephrotic syndrome developed in this patient after the start of radiation therapy for cancer metastases. At autopsy, the patient was found to have the crescentic form of glomerulonephritis, with evidence of substances from the prostate, including the enzyme prostatic-specific acid phosphatase and prostatic-specific antigen, in addition to factors from the immune system deposited in the glomeruli. These findings indicate that immune factors may be involved in the pathogenesis of crescentic glomerulonephritis. It is suggested that clinicians be aware of the potential for patients' developing kidney disease after radiation therapy for metastatic cancer; the radiation may cause the release of large amounts of tumor antigens and kidney damage due to immune factors. (Consumer Summary produced by Reliance Medical Information, Inc.)