Crescentic Glomerulonephritis Associated with Nonrenal Malignancies

Abstract

A review of 80 patients with the renal biopsy diagnosis of idiopathic glomerulonephritis with extracapillary proliferation (crescentic GN) disclosed 7 cases with a coexistent nonrenal malignancy; 6 carcinomas and 1 lymphoma. In a control group of 80 patients with the renal biopsy diagnosis of minimal change or focal segmental glomerulosclerosis, only 1 case of coexistent malignancy was found (chi-square = 4.74, p < 0.05). All of the malignancies occurred in patients older than 40 years of age and the prevalence of malignancy in patients with crescentic GN over the age of 40 was 20%. Light microscopy, immunofiuorescence, and electron microscopy revealed fibrin deposition in all cases and no evidence of anti-GBM or immune complex disease. 3 patients experienced a rapidly progressive course while renal function improved in 4 patients following treatment of the underlying malignancy. The pathogenic mechanisms leading to crescentic GN in patients with malignancy are unknown; however, the high prevalence of malignancy in crescentic GN patients older than 40 along with the improvement during the treatment of the underlying malignancy suggests an etiological relationship.

Minimal Change Nephrotic Syndrome Revealing Solid Tumors

“…Since this report, numer ous studies have confirmed that membranous [7][8][9] but also membranoproliferative [10] and crescentic [11][12][13] glomeru lonephritis may be of paraneoplastic origin. Surgical tumor removal may be followed by regression of the nephrotic syndrome.…”

Nephropathy Associated with Wilms’ Tumor

“…In our opinion extracapillary lesions, which have frequently been described, also deserve consideration: the relationship between crescentic glomerulonephritis and malignancies and the significance of this relation ship have been recently underlined [28][29][30].…”

“…In Drash's syndrome the hypothesis ol a common embryogenetic defect of the urogenital ridge has been supported [4,8,12,14]. It has been suggested [9,12,18], particularly in the absence of genital abnormalities, that an immunolog ical mechanism similar to that involved in glomerulone phritis associated with nonrenal tumors [10,[30][31][32][33] leads to deposits of immune complexes in the glomeruli.…”

Onco-Nephrology

“…Several reports suggest an association between rapidly progressive GN and malignancies, with a prevalence of cancer between 7% and 9% (27,28). A variety of tumors have been described (10).…”