Kidney Disease During Treatment for Metastatic Gastric Cancer

What happened, in summary

A 72-year-old man was diagnosed with advanced, poorly differentiated gastric adenocarcinoma with multiple liver and abdominal lymph-node metastases. He also had a blood clot in the left subclavian vein, which was treated with edoxaban. Seven cycles of S-1 plus oxaliplatin reduced the stomach tumor and metastatic disease. Five months later, however, he developed worsening ascites. Five weekly courses of paclitaxel again improved the cancer, but the fluid buildup continued.

Testing showed heavy protein loss in the urine, low albumin, declining kidney function, and swelling in both legs. A kidney biopsy and specialized protein analysis supported cryofibrinogen-associated glomerulonephritis, a rare kidney disorder. The blood clot resolved after 6 months of anticoagulation, but the nephrotic syndrome did not improve.

Chemotherapy was continued because the kidney disease was considered associated with the gastric cancer, but treatment was stopped 1 month after the biopsy when his performance status worsened. He died 5 months after the kidney biopsy amid chemotherapy side effects, malnutrition, progression of metastases, and a fatal cerebral bleed.