Nephrotic syndrome and neoplasm. The findings to date, with practical implications

The following points should be kept in mind in cases of nephrotic syndrome. Neoplasm (malignant or benign) occurs in approximately 10% of adults with nephrotic syndrome (15% of those over age 60). The neoplasm may be evident before, after, or simultaneously with the development of the nephrotic syndrome. Minimal change lesion in the kidney suggests possible Hodgkin's disease, while membranous nephropathy is more suggestive of possible carcinoma, although there are many exceptions to this generalization. Membrano-proliferative and focal sclerosis renal lesions also occur with diverse tumors. Strong evidence exists that in cases of carcinoma and nephrotic syndrome, the renal lesion is generally due to immune complexes--either tumor-associated antigens, fetal antigens, or viral antigens. In cases involving Hodgkin's disease, T-cell deficiency may be relevant in the genesis of the minimal change lesion and the nephrotic syndrome. Nephrotic syndrome often responds to effective treatment of the tumor and commonly recurs with relapse of the neoplasm. Nephrotic syndrome without apparent cause in an adult compels consideration of an associated neoplasm.