Contributed by: Dr. Umut Selamet, MD- Director of Onco-Nephrology Program
The glomerulus is the filtering part of the kidney. Paraneoplastic glomerular diseases are the diseases of the kidney glomerulus caused by products secreted by cancer cells located elsewhere other than kidney. Both solid tumors and hematological cancers are associated with paraneoplastic glomerular diseases. The types of glomerular diseases most frequently associated with cancer are membranous nephropathy, minimal change disease, focal segmental glomerulosclerosis, thrombotic microangiopathy, membranoproliferative glomerulonephritis, and amyloidosis. Among these, membranous nephropathy is by far the most frequent glomerular pathology associated with solid tumors. Hematologic malignancies are most frequently associated with minimal change disease and membranoproliferative glomerulonephritis and these associations are best described in Hodgkin disease and chronic lymphocytic leukemia, respectively.
Below is a table of glomerular diseases associated with different types of cancer types:
Reference: Umut Selamet, Ala Abudayyeh.Onco-Nephrology Highlights: Chronic kidney disease as a complication of cancer. J Onco-Nephrol. 2017; 1(2):74-80
Abbreviations: AML = acute myeloid leukemia; CLL = chronic lymphocytic leukemia; CML = chronic myeloid leukemia; FSGS = focal segmental glomerulosclerosis; GBM = glomerular basement membrane; GIST = gastrointestinal stromal tumor; GN = glomerulonephritis; MGUS = monoclonal gammopathy of undetermined significance; MPGN = membranoproliferative glomerulonephritis; RCC = renal cell carcinoma.
Unexplained proteinuria (spilling of protein in urine), hematuria (spilling of red blood cells in urine) and presence of white blood cells in urine in a patient with cancer or suspicion of cancer especially in older patients suggest paraneoplastic glomerular diseases. High blood pressure and swelling of legs are common clinical manifestations of these conditions. Definitive diagnosis is made by nephrologists with kidney biopsy. Treatment of paraneoplastic glomerular diseases are achieved with the treatment of the underlying cancer with goal of remission or cure of the cancer. Occasionally, paraneoplastic glomerular diseases can be observed before the diagnosis of the cancer. In the largest reported case series of kidney biopsy proven membranous nephropathy, it has been shown that 10% of the patients developed cancer within one year after the kidney biopsy. In those situations, aggressive work-up for diagnosis of cancer should be considered for early detection and the treatment of the cancer.
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