Paraneoplastic Glomerular Nephropathy [2022]: MOASC
Xiaojie Zhang, MD Poster On Paraneoplastic Glomerular Nephropathy
Hi, I’m Xiaojie Zhang, and I’m a first-year hematology-oncology fellow at the University of California San Diego. My poster today is about paraneoplastic glomerular nephropathy associated with renal cell carcinoma. This is an observational analysis of case reports published in the last four decades of patients with PGN associated with a diagnosis of renal cell carcinoma.
What is PGN (paraneoplastic glomerular disease)?
PGN (paraneoplastic glomerular diseases) is a rare manifestation or rare type of paraneoplastic syndromes, which is associated with a variety of solid tumors. Among the most common is renal cell carcinoma. PGN is poorly defined and poses a clinical challenge to physicians because it often mimics a variety of other chronic renal conditions, including chronic renal insufficiency, secondary to idiopathic glomerular nephropathy, or patients with renal impairment as a side effect of their cancer treatment. And it’s important to recognize this condition because it can be a manifestation of the new diagnosis of cancer or the recurrence of cancer, the management of PGN is not well defined, and therefore, an evidence-based approach is unknown.
So this study, as I’ve mentioned, looks through published reports on renal cell carcinoma associated with PGN over the last four decades. And we were able to include patients with biopsy-proven with nephropathy that’s temporarily correlated to a diagnosis of renal cell carcinoma. And we excluded patients who had renal insufficiency secondary to other conditions, such as a known underlying autoimmune disease.
Or known underlying CKD or chronic kidney disease in the setting of other conditions, we identified that, as expected, paraneoplastic nephropathy is associated temporarily with the diagnosis of renal cell cancer or carcinoma. Most were diagnosed at the time or around the time of their diagnosis with renal cell carcinoma.
Importantly a significant proportion, about 20% of patients first actually manifested with glomerular nephropathy prior to their diagnosis of RCC. And that also showed that treatment for malignancy, the underlying cause in the setting, PGN was important for improvements in renal. Membranous nephropathy was the most common type of glomerular nephropathy identified in our patient population.
What Type of Patients Does PGN Effect?
And our patients also overwhelmingly were male and overwhelmingly were over the age of 60, which is very important because clinicians need to have a high index of suspicion for a new patient who’s elderly and presenting with new nephritic or nephrotic syndrome. And our analysis showed both localized and metastatic.
Treatment for underlying cancer, meaning nephrectomy for localized disease or systemic therapy for metastatic disease, is important for improvement in renal outcomes. So improvement in the sense of decreased protein area. Decrease creatinine or clinical improvement in edema of the patients.
So overall, this study showed that this is a rare condition but an important one to have on our radars as oncologists and that treating the underlying cause of the glomerular nephrotic diseases among these patients with cancer which is cancer itself, is extremely important for leading to better outcomes for our patients.
Xiaojie Zhang, MD – About The Author, Credentials, and Affiliations
Xiaojie Zhang holds a medical degree and is currently working as a hematology-oncology fellow at the University of California, San Diego (UCSD).