Glomerular diseases and cancer: evaluation of underlying malignancy.
Onconephrology is an emerging medical subspecialty focused on the numerous interconnections between cancer and kidney diseases. Patient with malignancies commonly experience kidney problems including acute kidney injury, tumor lysis syndrome, fluid and electrolyte disorders and chronic kidney disease, often as a consequence of the anti-cancer treatment. Conversely, a number of glomerulopathies, tubulopathies and vascular renal diseases can early signal the presence of an underlying cancer. Furthermore, the administration of immunosuppressive drugs, especially cytotoxic drugs and calcineurin inhibitors, may strongly impair the immune response increasing the risk of cancer. The objective of this review article is to: (i) discuss paraneoplastic glomerular disease, (ii) review cancer as an adverse effect of immunosuppressive agents used to treat glomerulopathies, and (iii) in the absence of international approved guidelines, propose a screening program based on expert opinion aimed at guiding nephrologists to early detect malignancies during their clinical practice.
Department of Nephrology and Dialysis, G. Brotzu Hospital, Piazzale Ricchi, 1, 09134, Cagliari, Italy. antonellopani@aob.it.
Antonello
A
Pani
Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
Camillo
C
Porta
Nephrology and Dialysis Unit, Istituti Ospedalieri Cremona, Cremona, Italy.
Laura
L
Cosmai
Department of Nephrology and Dialysis, G. Brotzu Hospital, Piazzale Ricchi, 1, 09134, Cagliari, Italy.
Patrizia
P
Melis
Department of Nephrology and Dialysis, G. Brotzu Hospital, Piazzale Ricchi, 1, 09134, Cagliari, Italy.
Matteo
M
Floris
Department of Nephrology and Dialysis, G. Brotzu Hospital, Piazzale Ricchi, 1, 09134, Cagliari, Italy.
Doloretta
D
Piras
Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Milan, Italy.
Maurizio
M
Gallieni
Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.
Mitchell
M
Rosner
Nephrology and Dialysis Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Claudio
C
Ponticelli
D000970:Antineoplastic Agents / Q000009:adverse effects; D005921:Glomerulonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008495:Medical Oncology; D009369:Neoplasms / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D009398:Nephrology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
Cancer; Glomerular diseases; Immunosuppressive therapy; Membranous nephropathy; Nephrotic syndrome; Onconephrology