Murt Ahmet, Berke Ilay, Bruchfeld Annette, Caravaca-Fontán Fernando, Floege Jürgen, Frangou Eleni, Mirioglu Safak, Moran Sarah M, Steiger Stefanie, Stevens Kate I, Teng Onno Y K, Kronbichler Andreas
Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul Turkey.
Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
Clin Kidney J. 2025 Apr 10;18(5):sfaf101. doi: 10.1093/ckj/sfaf101. eCollection 2025 May.
Glomerular diseases may occur secondary to malignancies. Age-specific cancer screening is recommended for patients with glomerular diseases and may be extended based on the specific risk associated with the detected histopathologic pattern. Membranous nephropathy is the prototype of cancer-associated glomerulonephritis, with 10% of cases presenting with malignancy within a year from diagnosis. Among antigens that are expressed in patients with membranous nephropathy thrombospondin type 1 domain-containing 7A and neural epidermal growth factor-like-1 are often reported in patients with underlying malignancies. However, the risk of having a concurrent malignancy does not exceed 25%-30% when these antigens are expressed. While less frequent in other glomerulonephritides, co-occurrence of malignancy is reported in a substantial proportion of glomerular diseases including IgA nephropathy, podocytopathies with prominent podocyte foot process effacement such as minimal change disease as glomerular lesion pattern, amyloidosis, C3 glomerulopathy, monoclonal immunoglobulin deposition disease, or immune-complex-mediated glomerulonephritis. Treatment of malignancy-associated glomerulonephritis is usually directed toward treatment of the underlying malignancy with combinations of surgery, chemotherapy, and/or radiotherapy. Moreover, relapse of the malignancy may result in recurrence of glomerulonephritis. Refractoriness of glomerulonephritis to initial therapy may be due to an occult primary malignancy that was not diagnosed during initial cancer screening. In such a scenario a step-up diagnostic approach is recommended. In addition, re-screening may be sensible for relapsing patients who carry higher risks for cancer including patients of older age and those with a smoking history. This review focuses on the description of malignancies in the context of glomerular diseases and provides practical guidance on screening.
肾小球疾病可能继发于恶性肿瘤。建议对肾小球疾病患者进行特定年龄的癌症筛查，并可根据检测到的组织病理学模式相关的特定风险进行扩展。膜性肾病是癌症相关性肾小球肾炎的典型代表，10%的病例在诊断后一年内出现恶性肿瘤。在膜性肾病患者中表达的抗原中，含1型血小板反应蛋白结构域7A和神经表皮生长因子样-1常报道于有潜在恶性肿瘤的患者中。然而，当这些抗原表达时，并发恶性肿瘤的风险不超过25%-30%。虽然在其他肾小球肾炎中较少见，但在相当一部分肾小球疾病中都有恶性肿瘤并存的报道，包括IgA肾病、以肾小球病变模式如微小病变病等为主的足细胞病变伴显著足细胞足突消失、淀粉样变性、C3肾小球病、单克隆免疫球蛋白沉积病或免疫复合物介导的肾小球肾炎。癌症相关性肾小球肾炎的治疗通常针对潜在恶性肿瘤，采用手术、化疗和/或放疗相结合的方法。此外，恶性肿瘤的复发可能导致肾小球肾炎的复发。肾小球肾炎对初始治疗的难治性可能是由于在初始癌症筛查期间未诊断出的隐匿性原发性恶性肿瘤。在这种情况下，建议采用逐步升级的诊断方法。此外，对于复发且患癌风险较高的患者，包括老年患者和有吸烟史的患者，重新筛查可能是明智的。本综述重点描述了肾小球疾病背景下的恶性肿瘤，并提供了筛查的实用指导。
