Renal Cell Carcinoma–Associated Diabetes Mellitus Due to Paraneoplastic Syndrome in Maintenance Hemodialysis: A Case Report

A 59-year-old Japanese woman with a 22-year history of long-term hemodialysis was admitted to ourhospital for further examination of hyperglycemiaand anemia. Five months before hospitalization, herfasting plasma glucose value was 99 mg/dL and her glycated hemoglobin was 5.7%. On admission, herfasting plasma glucose value was 873 mg/dL, glycated hemoglobin was 16.2%, C-peptide reactivitywas 22.3 ng/mL (reference range, 0.5-3.0), and homeostasis model assessment of insulin resistance(HOMA-IR) was 10.6 (reference range,<2.0); the high HOMA-IR indicated high insulin resistance.Intensive insulin therapy was started for hyperglycemia, which required more than 40 units/day.Computed tomography showed a hypervascular lesion 2.2 cm in diameter on the right kidney;therefore, right nephrectomy was performed. Complete resection was confirmed, and the lesion wasdiagnosed as a clear cell type of renal cell carcinoma (RCC). Immediately after nephrectomy, glycemiccontrol normalized and administration of insulin was discontinued. Fourteen days after nephrectomy,the HOMA-IR decreased to 2.96. RCC that develops in patients receiving long-term hemodialysis hasbeen reported to be dialysis-related RCC, but there have been no reports suggesting a relationshipbetween dialysis-related RCC and diabetes. To our knowledge, this is thefirst report of RCC pre-senting with the paraneoplastic syndrome of acute-onset diabetes because of insulin resistance.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access articleunder the CC BY license (http://creativecommons.org/licenses/by/4.0/)