Glomerular lesions in malignancies

Glomerular lesions have been recognized in nearly all forms of malignant diseases. The incidence within each category of malignancy varies substantially but in most series represents less than 2% of the population. While there is a considerable variety of glomerular lesions, a number of general statements may be made. In Hodgkin's disease and other lymphomas, the most common lesion is minimal lesion nephrotic syndrome, reflecting possibly an anomaly of T cell function. Amyloidosis which used to be the commonest lesion has nearly disappeared. On the other hand, in patients with chronic lymphocytic leukemia a large proportion of glomerular lesions fall into the category of proliferative glomerulonephritis. In carcinoma the vast majority of glomerular lesions with proteinuria or the nephrotic syndrome are due to membranous glomerulonephritis. This suggests either a local alteration of fixed glomerular antigens, or localization of tumor antigens planted in the glomeruli leading to the formation of local immunocomplexes. Amyloid AA is still frequent in carcinoma and complicates as much as 3% of renal adenocarcinomas.