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Cancer-Associated Membranous — ESENeph MCQ

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ModerateGlomerulonephritisCancer-Associated MembranousESENeph

A 60-year-old man develops nephrotic syndrome. He has recently been diagnosed with a solid organ malignancy (lung cancer). Biopsy shows membranous nephropathy that is PLA2R-negative and THSD7A-negative. What should be considered?

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Correct answer: A — Secondary membranous nephropathy associated with malignancy – tumour treatment may improve kidney disease

PLA2R-negative, THSD7A-negative membranous nephropathy in a patient with newly diagnosed malignancy is highly suspicious for secondary (malignancy-associated) MN. In cancer-associated MN, tumour antigens may form circulating immune complexes that deposit in the glomerulus. Treatment should focus on the underlying malignancy, as tumour removal/treatment often leads to improvement in the nephrotic syndrome. Some newer antigens associated with cancer-related MN include EXT1/EXT2, NELL-1, and NCAM1.

Reference: KDIGO 2021 – GN Guideline; Ronco 2020 – Cancer-Associated MN