Screening for Cancer in Patients with Glomerular Diseases
Résumé
The diagnosis of malignancy in the setting of nephrotic syndrome is associated with a poor overall and kidney survival regardless of whether the glomerular disease represents a paraneoplastic manifestation or the cancer is a coincidental finding. The diagnosis of the neoplasia leads to consideration of antitumor therapy first, and may exclude the use of immunosuppressive agents. Although no cancer screening program has been established by nephrology societies because of the lack of evidence-based data, nephrologists usually question the cost-effectiveness of work-up for malignancy in newly diagnosed glomerulopathy. Furthermore, repeated screening during follow-up may be justified by treatment failure or early relapse despite suitable therapy, and by an excess risk of malignant diseases at months or years after the diagnosis of glomerulopathy, notably in membranous nephropathy (1). Evaluation of the risk of cancer-associated glomerulopathies is primary on the basis of patient-related risk factors and the histopathological diagnosis. Screening for cancer should include a routine evaluation, completed by targeted tests driven by each patient’s risk factors. In the case of membranous nephropathy where concerns of causative or associated malignancy are usually raised, it is important to consider whether the discovery of the new antigens M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) affect the decision to undergo, and the extent of, cancer screening.
Mots clés
Cancer
cost-benefit analysis
cytosolic phospholipases A2
early detection of cancer
follow-up studies
human PLA2R1 protein
humans
immunosuppressive agents
kidney
membranoproliferative glomerulonephritis
membranous nephropathy
neoplasms
nephrologists
nephrology
nephrotic syndrome
phospholipase A2 receptors
phospholipases A2
recurrence
risk factors
thrombospondins
treatment failure
Origine : Publication financée par une institution
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