Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis

Abstract

Paraneoplastic glomerulonephritis is a rare complication of malignancy that is frequently mistaken for idiopathic glomerulonephritis. Failure to recognize paraneoplastic glomerulonephritis can subject patients to ineffective and potentially harmful therapy. Pathology of paraneoplastic glomerulonephritis varies between different types of malignancies. This Review describes the association of glomerulonephritis with both solid tumors and hematological malignancies The pathogenetic mechanisms of many glomerular lesions seem to relate to altered immune responses in the presence of a malignancy Studies in the Buffalo/Mna rat model of spontaneous thymoma and nephrotic syndrome indicate that polarization of the immune response toward a T-helper-2 (T H 2) profile has an important role in the development of thymoma-associated glomerular lesions. Furthermore, overexpression of the T H 2 cytokine interleukin 13 in transgenic rats induces minimal change disease. Such findings from experimental studies might facilitate the identification of biomarkers that can distinguish paraneoplastic glomerulonephritis from idiopathic and other secondary glomerulonephritides. This Review describes potential pathogenetic mechanisms for paraneoplastic glomerulonephritides associated with different malignancies and highlights the need for a multidisciplinary approach to the management of patients with paraneoplastic glomerulonephritis.

A case of gefitinib-associated membranous nephropathy in treatment for pulmonary adenocarcinoma

“…As for IgA deposits in the present case, it could not be clarified if its cause is a drug, is associated with mucosal immunity of lung cancer, or complication of IgA nephropathy. Although rare, both solid tumor such as renal cell cancer, lung cancer, pancreas cancer, and hematological malignancies such as Hodgkin's and non-Hodgkin's diseases, could induce IgA nephropathy, termed paraneoplastic IgA nephropathy [15,16]. Interestingly, a case is recently reported that IgA nephropathy occurs in gefitinib treatment for lung cancer [17].…”

Remisión completa de síndrome nefrótico asociado a carcinoma cervicouterino luego de tratamiento del tumor: Comunicación de 2 casos

“…La NM generalmente se asocia a carcinomas sólidos y la NCM a procesos linfoproliferativos [10][11][12] . Se han descrito con menor frecuencia glomerulonefritis (GN) por IgA, GN mesangiocapilar, gloméruloesclerosis focal y segmentaria, GN crecéntica, amiloidosis y microangiopatía trombótica 12,13 .…”

“…Con menor frecuencia: renales, prostáticos, colorrectales, mamarios, pancreáticos, tímicos, etc 12,13 . Es extremadamente raro que un SN se asocie a tumores ginecológicos 1,11,12,14 .…”

“…Los pacientes con cán-ceres están expuestos a una antigenemia continua (antígenos tumorales, re-expresión de antígenos fetales, antígenos virales o antígenos autólogos de autoinmunidad) 18 . Antígenos tumorales como el antígeno carcinoembrionario, antígeno prostático específico y antígenos de melanoma se han encontrado en asociación a GPNP, sin embargo, su rol causal no se ha demostrado 13 . Excepcionalmente se han recuperado antígenos tumorales en los depósitos existentes en los glomérulos 9,20 .…”

“…Estos anticuerpos también se han encontrado en una proporción de GNPNP 23 . La prescripción de terapia inmunosupresora por la presunción de que la NM es idiopática puede perjudicar al paciente, ya que además de inefectiva puede ser dañina, acelerando la progresión del cáncer 13 . Es probable que ello haya sucedido en la primera paciente, la que además de corticoides recibió ciclofosfamida y MMF.…”