It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323

We report a case of 2X-year-old man with G4 chronic kidney disease (CKD G4). He had a decline in estimated glomerular filtration rate (eGFR) after the initiation of BEP (cisplatin, etoposide, bleomycin) therapy followed by VelP (ifosfamide, cisplatin, vinblastine) therapy for mixed germ cell testicular tumor. The patient’s eGFR did not recover during 59 months after chemotherapy, but showed a tendency to improve after treatment with yojinkodakuto. Yojinkodakuto was prepared by the IPCD (immersing powdered crude drugs) method. The IPCD method was adopted to ensure convenience and good quality prescription herbal medicines. Although eGFR fluctuated after yojinkodakuto treatment, at 3 years, serum creatinine (sCr) and eGFR progressed well, with sCr reducing from 3.98 mg/dL at initiation to 2.6 mg/dL and eGFR increasing from 16 mL/min/1.73 m2 to 25.4 mL/min/1.73 m2. In addition, a long-term eGFR plot analysis confirmed the 3-year improvement trend.