Nephrotic Syndrome Associated with Thymoma

Thymoma is associated with a wide variety of paraneoplastic syndromes such as myasthenia gravis, pure red cell aplasia, and hypogammaglobulinemia. Paraneoplastic glomerulonephritis is a rare clinical presentation of malignancy. This condition often goes undetected as it has no specific clinical symptoms and signs. Approximately 2% of thymoma patients have been reported to have paraneoplastic glomerulonephritis, and the nephrotic syndrome has been shown to be a clinical manifestation of the disorder. We report two cases diagnosed to have thymoma and nephrotic syndrome. Renal biopsy showed that one case had focal segmental glomerulosclerosis, whereas the other had minimal change disease. In case 1, the nephrotic syndrome was diagnosed before thymoma was detected, while in case 2, the symptomatic nephrotic syndrome occurred after thymoma treatment. Because parathymic nephropathy often remains undiagnosed and interferes with treatment, the possibility of the nephrotic syndrome should always be considered throughout the course of thymoma management, particularly in patients who also present with anasarca or hypoalbuminemia. A multidisciplinary approach is needed. Besides, it is to be noted that the nephrotic syndrome may be the initial presentation of thymoma.