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Tumorbasierte Induktion von Glomerulonephritiden

Tumor-based induction of glomerulonephritis

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Der Nephrologe Aims and scope

Zusammenfassung

Glomerulonephritiden sind seltene immunvermittelte Nierenerkrankungen, die unbehandelt häufig zu einem Verlust der Nierenfunktion führen. Die Pathogenese der einzelnen Glomerulonephritisentitäten ist vielfältig, gleichzeitig bleiben die genauen immunologischen Mechanismen und Mediatoren zu großen Teilen ungeklärt. Vor über 50 Jahren wurde eine erhöhte Prävalenz von Tumoren bei Patienten mit Glomerulonephritiden beschrieben, sodass häufig von einer sekundären Form der Glomerulonephritis ausgegangen und bei Diagnose ein Tumorscreening empfohlen wird. Ob die Entstehung einer Glomerulonephritis auch kausal mit der Diagnose eines Tumors zusammenhängt, wird weiterhin kontrovers diskutiert, insbesondere im Hinblick darauf, dass Patienten mit Glomerulonephritis häufig älter sind und ein höheres Tumorrisiko aufweisen. Nicht nur die Tumorprävalenz und -inzidenz, sondern auch die assoziierten Tumorentitäten unterscheiden sich je nach Glomerulonephritisform erheblich. In diesem Zusammenhang nimmt die membranöse Glomerulonephritis eine Sonderstellung ein, nicht nur angesichts der hohen Tumorprävalenz bei diesen Patienten, sondern auch aufgrund der Fortschritte der letzten 10 Jahre bei der Aufklärung der Pathogenese dieser Erkrankung. Ein besseres Verständnis der Pathomechanismen der Entstehung einer Glomerulonephritis würde es ermöglichen, eine Tumorsuche an das individuelle Risiko des Patienten anzupassen, sodass Hochrisikopatienten identifiziert und unnötige Untersuchungen vermieden werden können.

Abstract

Glomerulonephritides represent rare immune-mediated renal diseases, which untreated often lead to renal failure and end-stage kidney disease. The pathogenesis of the various glomerulonephritis entities is diverse; however, the precise immunological mechanisms and mediators leading to these diseases remain largely unknown. A high prevalence of tumors in patients diagnosed with glomerulonephritis was described more than 50 years ago, leading to the assumption of a secondary form of glomerulonephritis and to the recommendation to screen patients diagnosed with glomerulonephritis for tumors. At the same time a causality link between the diagnosis of a tumor and the development of glomerulonephritis was never proven and remains controversial, especially considering the fact that patients with glomerulonephritis are often older and have a higher risk for a tumor. Not only the tumor incidence and prevalence but also the associated tumor entities differ considerably between the different glomerulonephritis forms as do the suggested pathomechanisms linking the two diseases. In this context, membranous nephropathy holds a special position, not only because of the high tumor prevalence in these patients but also due to the advances made in the last 10 years in understanding the pathogenesis of the disease. Elucidation of the pathomechanisms leading to the development of glomerulonephritis would enable the diagnostic screen for a tumor to be adapted to the individual risk of the patient so that high-risk patients can be identified and unnecessary diagnostic procedures can be avoided.

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  1. III. Medizinische Klinik und Poliklinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    E. Hoxha & T. B. Huber

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Hoxha, E., Huber, T.B. Tumorbasierte Induktion von Glomerulonephritiden. Nephrologe 15, 71–80 (2020). https://doi.org/10.1007/s11560-020-00404-y

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