Malignancies and glomerulonephritis: when to suspect and when to screen?

Area of Science:

• Nephrology
• Oncology

Background:

• Glomerular diseases can be secondary to malignancies.
• Membranous nephropathy is a key example of cancer-associated glomerulonephritis, with 10% of cases diagnosed alongside malignancy within a year.
• Certain antigens like thrombospondin type 1 domain-containing 7A and neural epidermal growth factor-like-1 are associated with malignancy in membranous nephropathy.

Purpose of the Study:

• To review the association between malignancies and glomerular diseases.
• To provide practical guidance on cancer screening for patients with glomerular diseases.

Main Methods:

• Literature review focusing on the co-occurrence of glomerular diseases and malignancies.
• Analysis of diagnostic and screening approaches for malignancy-associated glomerulonephritis.

Main Results:

• Malignancy risk in membranous nephropathy can be up to 10% within a year; specific antigens are identified but don't guarantee high risk.
• Other glomerulonephritides like IgA nephropathy and C3 glomerulopathy also show a substantial co-occurrence with malignancy.
• Treatment of malignancy-associated glomerulonephritis involves addressing the underlying cancer; refractory cases may require further diagnostic investigation.

Conclusions:

• Age-specific cancer screening is recommended for glomerular disease patients, tailored to histopathologic findings.
• Re-screening is advised for relapsing patients, particularly older individuals or those with a smoking history.
• Identifying occult malignancies is crucial, especially when glomerulonephritis is refractory to initial treatment.