Glomerular diseases and cancer: evaluation of underlying malignancy

J Nephrol. 2016 Apr;29(2):143-152. doi: 10.1007/s40620-015-0234-9. Epub 2015 Oct 26.

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.

Keywords: Cancer; Glomerular diseases; Immunosuppressive therapy; Membranous nephropathy; Nephrotic syndrome; Onconephrology.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Glomerulonephritis* / diagnosis
  • Glomerulonephritis* / drug therapy
  • Glomerulonephritis* / epidemiology
  • Glomerulonephritis* / immunology
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Medical Oncology*
  • Neoplasms* / chemically induced
  • Neoplasms* / diagnosis
  • Neoplasms* / drug therapy
  • Neoplasms* / epidemiology
  • Neoplasms* / immunology
  • Nephrology*
  • Paraneoplastic Syndromes* / diagnosis
  • Paraneoplastic Syndromes* / epidemiology
  • Paraneoplastic Syndromes* / therapy
  • Risk Assessment
  • Risk Factors

Substances

  • Antineoplastic Agents
  • Immunosuppressive Agents