Critical evaluation of cancer risks in glomerular disease

• Published in: Translational oncology Vol. 19; p. 101376
• Main Authors: Thet, Zaw, Lam, Alfred K., Ranganathan, Dwarakanathan, Aung, Soe Yu, Han, Thin, Khoo, Tien K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2022; Neoplasia Press; Elsevier
• Subjects: Cancers; Glomerular disease; Glomerulonephritis; Malignancy; Nephrotic syndrome; Review; Glomerulonephritis; Malignancy; Nephrotic syndrome; Cancers; Glomerular disease
• ISSN: 1936-5233; 1936-5233
• DOI: 10.1016/j.tranon.2022.101376

•The increased cancer incidence in patients with glomerular disease can be secondary to an intrinsic immune dysfunction associated with the disease or/and extrinsic factors, especially immunosuppressants.•Paraneoplastic glomerulopathy is sometimes misdiagnosed as primary glomerulopathy.•The treatment for paraneoplastic glomerulopathy is different from primary glomerular disease.•In membranous nephropathy, serum circulating autoantibodies against PLA2R and THSD7A, immunohistochemical tissue markers for glomerular PLA2R, THSD7A and specific types of immunoglobulin G (IgG) may be used for identifying underlying malignancies.•A scheme of screening of cancers frequently reported in the setting of glomerular disease is important.
The increased cancer incidence in patients with glomerular disease can be secondary to an intrinsic immune dysfunction associated with the disease or/and extrinsic factors, especially immunosuppressants. The treatment for paraneoplastic glomerulopathy is different from primary glomerular disease. Immunosuppressive therapy often used for primary glomerulopathy may aggravate concomitant cancers in patients with paraneoplastic glomerulopathy. In membranous nephropathy (MN), measurement of serum circulating autoantibodies against podocyte transmembrane glycoprotein M-type phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A), immunohistochemical staining of kidney tissue for glomerular PLA2R, THSD7A, neural epidermal growth factor-like 1 protein (NELL-1) and specific types of immunoglobulin G (IgG) may be useful adjuncts when screening for underlying malignancies. This review addresses overall cancer risks in individuals with glomerular diseases and employment of biomarkers available for MN. We propose a scheme of screening of cancers frequently reported in the setting of glomerular disease.
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