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Kidney Involvement in Systemic Calcitonin Amyloidosis Associated With Medullary Thyroid Carcinoma.

Authors
  • Koopman, Timco1
  • Niedlich-den Herder, Cindy2
  • Stegeman, Coen A3
  • Links, Thera P4
  • Bijzet, Johan5
  • Hazenberg, Bouke P C5
  • Diepstra, Arjan2
  • 1 Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: [email protected] , (Netherlands)
  • 2 Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands. , (Netherlands)
  • 3 Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, the Netherlands. , (Netherlands)
  • 4 Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands. , (Netherlands)
  • 5 Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. , (Netherlands)
Type
Published Article
Journal
American Journal of Kidney Diseases
Publisher
Elsevier
Publication Date
Dec 23, 2016
Identifiers
DOI: 10.1053/j.ajkd.2016.09.027
PMID: 28024929
Source
Medline
Keywords
License
Unknown

Abstract

A 52-year-old woman with widely disseminated medullary thyroid carcinoma developed nephrotic syndrome and slowly decreasing kidney function. A kidney biopsy was performed to differentiate between malignancy-associated membranous glomerulopathy and tyrosine kinase inhibitor-induced focal segmental glomerulosclerosis. Surprisingly, the biopsy specimen revealed diffuse glomerular deposition of amyloid that was proved to be derived from the calcitonin hormone (Acal), produced by the medullary thyroid carcinoma. This amyloid was also present in an abdominal fat pad biopsy. Although local ACal deposition is a characteristic feature of medullary thyroid carcinoma, the systemic amyloidosis involving the kidney that is presented in this case report has not to our knowledge been described previously and may be the result of long-term high plasma calcitonin levels. Our case illustrates that systemic calcitonin amyloidosis should be considered in the differential diagnosis of proteinuria in patients with medullary thyroid carcinoma.

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