A Case Series of Nephrotic Syndrome: A Harbinger of Catastrophic Oncologic Diseases.

INTRODUCTION: A cancer patient can have numerous complications involving the kidneys, ranging from acute kidney injury, chronic kidney disease, glomerulopathies, electrolyte, and acid-base disorders. It can be due to the malignancy itself or due to chemotherapeutic agents. Paraneoplastic glomerulopathy is a rare presentation of neoplastic disease. CASE DISCUSSION: We present a case series of two patients presenting with nephrotic syndrome as a paraneoplastic syndrome associated with a gynecologic tumor. Both patients responded only partially to steroids and immunosuppressive therapy. Complete remission was only achieved after treatment of primary malignancy. CONCLUSION: It is critical to recognize this entity as immunosuppression may induce a flare in the tumor course and worsen outcomes. So, age-appropriate screening of malignancy should ideally be performed in any adult patient with nephrotic syndrome.

A Rare Cause of Breathlessness in a Patient on Hemodialysis.

Patients suffering from end stage renal disease (ESRD) often present to the emergency with breathlessness, mostly due to fluid overload. We report a rare case of recurrent unilateral massive pleural effusion in an ESRD patient on maintenance hemodialysis (MHD). The patient was on MHD thrice weekly for the last 2 years with right internal jugular vein (IJV) tunneled cuffed catheter (TCC). Chylothorax was identified as the cause of recurrent pleural effusion which was due to superior vena cava stenosis (SVCO). It was managed successfully by balloon venoplasty of SVC and anticoagulation. SVCO is a rare but a serious complication in patients on long term indwelling dialysis catheters. Physicians involved in the care of dialysis patients must be aware about complications of long term dialysis catheters like central vein stenosis. A strong suspicion of chylothorax should be reserved for a patient with recurrent unilateral pleural effusion and long term dialysis catheters.