Paraneoplastic glomerular disease: The struggle is real

Abstract

Over the past decade, the relationships between various kidney disease and cancer have been established, but not fully elucidated. Development of acute kidney injury or chronic kidney disease as a side effect of cancer treatment is not uncommon. However, renal paraneoplastic diseases are rather unique and less known examples of the association between kidney disease and cancer. These conditions are of importance to the nephrologist as they may be the initial presentation of an underlying malignancy and may not respond to the usual therapies used for their non-paraneoplastic variants. This article will discuss the pathogenesis and challenges in management of paraneoplastic glomerular diseases.

Pathology spectrum of kidney damage in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma in the real practice

“…MIgassociated types of damage are also well described in NHL/ CLL setting, and include immunotactoid GN, fibrillary GN, cryo-GN, AL amyloidosis, PGNMID, light chain deposition disease, and even ICMDD. [2][3][4][5][6][9][10][11][15][16][17][18][19][20] In our NHL/ CLL sub-group, we also found predominantly paraneoplastic GN, presenting with MPGN, MN, and MCD; with just few cases of MIg-related patterns (PGNMID and monotypic MN). It is worth noting that we also discovered AA amyloidosis in the patient with spine B-cell lymphoma, paraplegia, pelvic floor dysfunction, chronic urinary tract infection, multiple chronic bedsores, and severe NS.…”

“…The most common HL-associated kidney disease is MCD with NS; the second most reported kidney lesion historically considered is AA amyloidosis, however, more recently the number of such cases have decreased. 6,[8][9][10] FSGS and crescentic GN also found in some HL patients. 2,11 In our study, the incidence of NS was higher in the HL sub-group compared to NHL/CLL and LPL, even though the difference was not statistically significant.…”

Paraneoplastic glomerulopathy

“…The reader is also referred to multiple excellent, comprehensive reviews on PNG. [1][2][3] An approach to the classification of paraneoplastic glomerulopathy PNG can be divided into three broad categories of disease (Table 1). First, PNG may occur in the setting of dysproteinemia, where it is frequently, but not always, associated with an underlying hematolymphoid neoplasm.…”

Acute kidney injury in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma: One center experience

“…We consider PGNMID, AL amyloidosis, MPGN, MN, FSGS, and IgAN, which totally presented in 13 cases, as NHL/CLL-related and HL-related causes of the underlying CKD, as all these variants of kidney damage were described in the NHL/CLL and HL setting. 3,6,16,[22][23][24][25][26][27][28][29] PGNMID and AL resulted from direct paraprotein deposition, while MPGN, MN, FSGS, and IgAN represent paraneoplastic spectrum. 24,25 AKI on the top of CKD in these 13 patients was pre-renal (9 cases), caused by LI (3 cases) and TLS (1 case).…”