[Glomerulonephritis in neoplastic disease].

Glomerulonephritis are known to be associated with cancer disease. Although these association is well documented but the number of conditions must be fulfilled to establish a causal relationship between the malignancy and glomerulopathy. Secondary membranous glomerulonephritis is relatively often noted type of glomerulopathy, but other types have been mentioned, especially IgA nephropathy, minimal-change disease, rapidly progressive glomerulonephritis and anti-GBM disease in the case of neoplastic obstruction of urinary tract. The most frequent types of malignancies are pulmonary, renal and gastrointestinal solid tumours. The pathogenesis is immunological due to the involvement of tumor associated antigens, re-expressed fetal antigens, and/or viral antigens. Immune complexes (circulating or formed in situ) containing tumor-associated antigens are suspected of causing glomerular injury. The diagnosis of malignancy may be established either before, concomitant or after the development of nephrotic syndrome. Slow remission of nephrotic syndrome is sometimes observed after resection or successful treatment of the tumor, and relapse has been reported during the relapse of cancer. The non-specific treatment of nephrotic syndrome is recommended and the immunosuppression generally should be avoided because this may exacerbate the malignancy. Sometimes also antiviral therapy can be considered. Patients with nephrotic syndrome due to membranous glomerulonephritis, aged over 50, should be carefully screened for malignancy. The tumor prognosis determines patient outcome.