Growth factors and proinflammatory cytokines in the renal involvement of POEMS syndrome

The POEMS syndrome is a multisystemic syndrome associated with plasma cell dyscrasia, characterized by the combination of polyneuropathy, organomegaly , endocrinopathy, M protein, and skin changes, Renal involvement in POEMS s yndrome is rare (26 reported cases), It has been described as membranoproli ferative glomerulonephritis-like lesions (MPGN-like), mesangiolytic glomeru lonephritis, or thrombotic microangiopathy, Proinflammatory cytokines (TNF- alpha, IL-1, IL-6) have been implicated in the physiopathogenesis of POEMS syndrome, particularly when there is renal involvement. Growth factors (FGF -beta, TGF-beta, PDGF) have been implicated in renal lesions of the same hi stological type but of different origins, An increase in serum vascular end othelial growth factor (VEGF) has been reported in POEMS syndrome (20 of 22 cases), Circulating levels of these factors were determined in 4 patients with POEMS and renal involvement (3 MPGN-like, 1 MPGN-like, and mesangiolys is) and compared with those obtained in 4 patients with POEMS without clini cal renal involvement and in 4 patients with primitive membranoproliferativ e glomerulonephritis (MPGN), TNF-alpha, IL-1 beta, and IL-6 were determined with an immunoradiometric assay, and VEGF, PDGF, FGF-beta, and TGF-beta wi th an enzyme-linked immunosorbent assay. Among the patients with POEMS synd rome, there was no difference in proinflammatory cytokines and growth facto rs between those with or without renal involvement. VEGF is the only growth factor that differentiates MPGN in POEMS syndrome from primitive MPGN. (C) 1999 by the National Kidney Foundation, Inc.