Glomerular diseases and cancer: evaluation of underlying malignancy

Abstract

Onconephrology is an emerging medical subspecialty focused on the numerous interconnections between cancer and kidney diseases. Patient with malignancies commonly experience kidney problems including acute kidney injury, tumor lysis syndrome, fluid and electrolyte disorders and chronic kidney disease, often as a consequence of the anti-cancer treatment. Conversely, a number of glomerulopathies, tubulopathies and vascular renal diseases can early signal the presence of an underlying cancer. Furthermore, the administration of immunosuppressive drugs, especially cytotoxic drugs and calcineurin inhibitors, may strongly impair the immune response increasing the risk of cancer. The objective of this review article is to: (i) discuss paraneoplastic glomerular disease, (ii) review cancer as an adverse effect of immunosuppressive agents used to treat glomerulopathies, and (iii) in the absence of international approved guidelines, propose a screening program based on expert opinion aimed at guiding nephrologists to early detect malignancies during their clinical practice.

Desmoid abdominal tumour: a clinical case report and brief literature review

“…In general, glomerular injury is caused by secretion of tumor cell products, such as growth factors, cytokines, tumor antigens or hormones or by altered immune response in the presence of malignancy. 18 Deterioration of patient's performance status and irreversible renal failure defined poor disease prognosis and failure to provide any curative treatment strategy.…”

Membranous nephropathy and the Henle–Koch postulates

“…In the latter, TSHD7A was also found in CD21 + follicular dendritic cells, a cell type responsible for priming autoantigen-specific lymphocytes, a process that ultimately triggers initiation of TSHD7A antibody production in paraneoplastic MN 1 . This case not only challenges the idea that anti-TSHD7A explicitly identifies primary MN but rather raises the question of whether anti-TSHD7A preferably occurs in paraneoplastic MN 9 . The researchers identified malignancies in seven of 25 patients with anti-TSHD7A-positive MN but other cohorts have not been examined to confirm this finding.…”

Treatment of Steroid-Resistant Nephrotic Syndrome

“…Of particular concern regarding the use of cytotoxic drugs is the long-term cancer risk although this risk has not been quantified in children [48,49]. There is generally a lack of data regarding cumulative dose toxicity for the various agents mentioned above, but this is an important factor to bear in mind and should be discussed with parents and child before the onset of therapy.…”