A case of membranous glomerulopathy associated with lung cancer and review of the literature

Abstract

Abstract. Membraneous nephropathy (MN) is the most commonly occurring nephrotic syndrome in adults as well as the most common paraneoplastic nephropathy associated with solid tumors, and it is mostly associated with gastrointestinal system and lung carcinomas. Accurate diagnosis is important as the treatment of paraneoplastic glomerulonephritis is very varied from that of idiopathic ones. In the current report, a case of a patient that was referred with proteinuria and edema and was diagnosed with lung cancer, and responded markedly to treatment of malignancy, with improvement of MN, is presented. Active cancer is present in all patients with paraneoplastic MN. In numerous patients, the paraneoplastic MN and cancer diagnoses are made within one year of each other. The treatment of paraneoplastic syndromes is usually associated with the treatment of primary malignancy. There are conflicting data on which treatment modality is more suitable. In conclusion, further studies are required in order to determine the actual incidence of cancer in patients with nephropathy, explain the physiopathological association between cancer and nephropathy and to determine the most suitable treatment approaches. IntroductionNephrotic syndrome is one of the most easily diagnosed kidney diseases due to its established criteria. It is a clinical entity characterized by proteinuria >3.5 g/1.73 m 2 for 24 h along with hypoalbuminemia, edema and hyperlipidemia. In glomerular diseases presenting with nephrotic syndrome, there is a defect in glomerular filtration barrier (1). Membranous nephropathy (MN), is a pathological entity characterized by diffuse thickening in the glomerular basement membrane, as viewed under light microscopy. Although 75% of MN cases are idiopathic, the remaining are associated with infections, malignancies, autoimmune diseases and drug toxicity (2).The diagnosis of paraneoplastic nephropathy is made according to certain criteria: Clinical and histological remission with complete removal of the tumor or complete remission with chemotherapy, nephrological relapse concurrent with the recurrence of malignancy and physiological connection between two diseases including tumor antigens and antitumor antibodies along with immune deposits (3). MN is the nephrotic syndrome occurring most frequently in adults and the paraneoplastic nephropathy detected most commonly in association with solid tumors (4), and it is most commonly associated with the gastrointestinal system and lung adenocarcinomas (1). Accurate diagnosis is important as the treatment of paraneoplastic glomerulonephritis is different from that of idiopathic nephropathies. The aim of the present report was to present the case of a patient who was referred with proteinuria and edema, was diagnosed with MN and subsequently lung cancer and responded markedly to treatment of malignancy with improvement of MN. Case reportA 62 year old male patient with a history of coronary artery disease and a history of smoking (36 pack-years) underwent kidney biopsy in July 2012 du...

Duodenal neuroendocrine tumour associated with minimal change glomerulonephritis

“…While a variety of malignancies have been linked to glomerular disease,1 2 we believe this to be the first reported case of neuroendocrine tumour (NET) and minimal change glomerulonephritis in adults 3. The aetiology of glomerulopathy in cancer does not appear to be related to tumour burden, metastatic spread or the site or extent of invasion, but to the secretion of substances from the tumour cells 1.…”

“…The aetiology of glomerulopathy in cancer does not appear to be related to tumour burden, metastatic spread or the site or extent of invasion, but to the secretion of substances from the tumour cells 1. The most commonly reported associated malignancies are lung, gastric, renal, prostate, breast and colon cancers; however, robust data on the incidence of paraneoplastic glomerular disease are lacking 2. Nephrologists have not reached a consensus on the value of investigating for malignancy in patients with glomerulopathies,4 but as standard treatment may be less effective in a paraneoplastic glomerulopathy, prompt diagnosis is important to ensure patients do not receive ineffective and potentially harmful treatments 1…”

Complete remission of membranous nephropathy in a patient with lung adenocarcinoma treated with erlotinib

“…Paraneoplastic nephropathy refers to glomerular lesions that present as membranous nephropathy, minimal change disease or membranoproliferative glomerulonephritis; that are not directly related to tumour burden, invasion or metastasis; and which might be associated with the products secreted by malignant cells . Membranous nephropathy is the most commonly seen paraneoplastic nephropathy in adults and is always associated with lung cancer, tumours of the digestive system and prostate adenocarcinoma. The pathogenicity of these tumours might be related to the glomerular lesions resulting from the deposition of immune complexes composed of tumour antigen and specific antibody …”

“…Among the membranous nephropathies secondary to known diseases, solid cancers account for 5.8%‐10.9% of all patients with membranous nephropathies . With regard to lung cancer, membranous nephropathy has been reported in patients with small‐cell lung cancers and non‐small‐cell lung cancers . However, since another underlying disease might be the actual cause of the nephropathy, if we suspect that a patient has paraneoplastic membranous nephropathy, the patient must be carefully evaluated for comorbidities and for types of medication and treatments already being administered to exclude other potential causes of membranous nephropathy.…”

Paraneoplastic Syndromes in Lung Cancer

“…Effective cancer treatment will be sufficient when paraneoplastic glomerulopathies including membranous nephropathy are detected. However, renal functions should still be monitored and appropriately managed [74].…”