Renal impairment in solid tumors
Introduction
Introduction to kidney damage in solid tumors Malignant tumors that cause kidney damage can be divided into two broad categories, including the kidney itself and extra-renal tumors. The incidence of renal damage caused by tumors is <1%. The main clinical manifestations are nephrotic syndrome or nephritic syndrome. Renal damage can be seen in various malignant tumors, most commonly in lung cancer, stomach cancer, breast cancer and colon cancer. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: nephrotic syndrome hyperuricemia
Cause
Causes of renal damage in solid tumors
Tumor (30%):
The disease is caused by tumors, glomerular damage can occur in a variety of tumors, in malignant tumors, more important are lung, colon, stomach, breast adenocarcinoma; in addition, lymphoma (mainly Hodgkin's disease) And leukemia can also cause glomerular damage.
Immunological abnormality mediated (20%):
The main mechanisms of renal damage include direct invasion of the kidney by extra-renal tumors, abnormalities in immunology, abnormalities in tumor metabolism, and side effects (chemotherapeutic drugs and tumor lysates) during the treatment of tumors, but tumor-induced renal damage manifests as the onset of nephrotic syndrome. The mechanism is mainly mediated through immunological abnormalities.
Glomerular lesions (20%):
The immunological abnormal mechanism of tumor-induced renal damage is mainly immune complex-mediated glomerular lesions, more common in Hodgkin's disease and non-Hodgkin's lymphoma, chronic lymphocytic leukemia, lung cancer, colon cancer, breast cancer, etc. Immunological abnormalities mainly include the following aspects:
1. Tumor-associated antigen stimulates the host to produce anti-tumor antibodies: antigen-antibody forms soluble immune complexes, which are deposited in glomeruli and cause disease. It was found that 1 case of colon cancer with liver metastasis and nephrotic syndrome, renal biopsy showed renal basement membrane Thickened immunofluorescence showed that IgG, IgA, IgM and C3 were diffusely deposited along the glomerular capillary wall in granular form, and carcinoembryonic antigen (CEA) was extracted from liver metastatic nodules to immunize sheep to obtain anti-CEA pure serum. Renal tissue was examined with fluorescently labeled anti-CEA serum and diffuse coarse granular carcinoembryonic antigen deposition was found on the glomerular basement membrane.
2. Immune complex nephritis caused by viral antigen-antibody complex: Old-stone reports the detection of immune complexes in the serum of Burkitt's lymphoma patients in Africa, EB virus antigen, antibody and complement deposition in the glomerulus; and acute leukemia patients The mesangial membrane is found to cause tumor virus antigen deposition.
3. Non-neoplastic autoantigen-induced disease: Higgins reported that patients with disseminated oat cell carcinoma complicated with nephrotic syndrome, antinuclear antibodies were detected in serum, IgG, C3 deposition, deposition were found in the glomerular basement membrane and epithelium. The cells were positive for DNA-specific staining, and also showed extracellular localization in the necrotic area and metastasis site of the tumor, indicating that the necrotic tumor produced a large amount of tumor cell DNA, which produced anti-DNA antibodies and formed immune complexes in vivo. It causes kidney damage in tumor patients and supports the idea that tumor patients can produce organ-specific autoantibodies.
4. Immune surveillance function defects: tumor patients contact with certain antigens to produce antigen-antibody immune complex disease.
5. Hodgkin's disease complicated with minimally pathological nephropathy: Some authors believe that it is due to defects in T lymphocyte function, some researchers believe that due to tumor cells producing certain lymphokines or lymphotoxin, causing increased glomerular basement membrane permeability .
6. Tumor secondary amyloidosis: Many malignant tumors can be secondary to renal amyloidosis, especially renal cell carcinoma, Hodgkin's disease and chronic lymphocytic leukemia.
Prevention
Kidney damage prevention of solid tumors
Prevention of this disease is the same as other malignant tumors, and tertiary prevention can be used.
1. Primary prevention is the prevention of the cause, and its goal is to prevent the occurrence of cancer. Its tasks include studying the causes and risk factors of various cancers, and taking specific cancers, cancer-promoting factors and pathogenic conditions in vitro and in vivo for chemical, physical, biological and other diseases. Preventive measures, and for the health of the body, take environmental protection, suitable diet, suitable for sports, to promote physical and mental health.
2. Secondary prevention or preclinical prevention, the goal is to prevent the development of initial disease, including early detection of cancer, early diagnosis, early treatment, to prevent or slow the development of the disease, as early as possible to reverse to stage 0.
3. Tertiary prevention is clinical (stage) prevention or rehabilitation prevention. The goal is to prevent the deterioration of the disease and the occurrence of disability. The task is to adopt multidisciplinary diagnosis (MDD) and treatment (MDT), and to choose the right and the best treatment plan. Fight cancer as soon as possible, try to promote recovery and rehabilitation, prolong life, improve quality of life, and even reintegrate into society.
Complication
Kidney damage complications of solid tumors Complications nephrotic syndrome hyperuricemia
This disease is one of the complications of the tumor. It is mainly caused by nephrotic syndrome. Kidney damage caused by tumor, in addition to glomerular disease, can also cause urate kidney disease, high calcium disease, low potassium. Sexual kidney disease, acute renal failure caused by acute hyperuricemia (in some cancer chemotherapy), obstructive kidney disease, etc.
Symptom
Symptoms of kidney damage in solid tumors Common symptoms Lymph node pain Kidney damage Lymph node enlargement Skin itching Decreased glomerular filtration rate
Renal damage of solid tumors In addition to the extra-renal clinical manifestations of the tumor itself, renal damage is often manifested as proteinuria or nephrotic syndrome, active urine sediment changes or glomerular filtration rate is reduced, and obvious renal damage is rare. If there is obvious renal damage, it is often secondary to proliferative glomerulonephritis.
The time of tumor-induced renal damage and the diagnosis of tumors is still irregular. It is reported that nephrotic syndrome appears 14 months before the tumor is diagnosed, or nephrotic syndrome appears several months or years after the tumor is diagnosed. The symptoms of kidney disease are alleviated by the effective treatment of the tumor, and are aggravated with the recurrence of the tumor. The most common glomerular damage caused by adenocarcinoma is nephrotic syndrome.
Some people think that 6% to 10% of the primary nephrotic syndrome of membranous nephritis may be secondary to occult malignant tumors. Lymphoma and leukemia may also cause glomerular damage. Hodgkin's disease is most often caused by tiny Lesions, occasionally acute or chronic nephritic syndrome, nephrotic syndrome is the main clinical manifestation of glomerular damage in Hodgkin's disease. When the clinical condition of Hodgkin's disease fluctuates, proteinuria may increase or decrease, tumor Caused by glomerular damage, can be converted into chronic renal failure, kidney damage caused by tumors, in addition to glomerular diseases, can also cause urate kidney disease, high calcium kidney disease, hypokalemia, acute high Acute renal failure caused by uric acidemia (in some cases of chemotherapy, obstructive kidney disease, etc.).
Examine
Examination of kidney damage in solid tumors
Test abnormalities associated with tumor-induced renal damage are:
1. Abnormal urine test: a large amount of proteinuria, urine protein quantitation > 3.5g / 24h, and active urine sediment changes such as red blood cells, white blood cells and various casts.
2. Renal function test: glomerular filtration rate may decrease, blood BUN, Cr increase.
3. ESR increased: Most patients with ESR>60mm/h, more than 20% of patients with ESR can exceed 100mm/h, but it should be noted that patients with nephrotic syndrome have significantly increased ESR and cannot be used as a suggestive tumor or some Indications for the presence of chronic inflammatory diseases.
Kidney biopsy:
1. Light microscopy:
(1) Glomerular basement membrane thickening, showing membranous nephropathy.
(2) In addition to glomerular basement membrane thickening, there is still mesangial hyperplasia, showing mesangial capillary proliferative nephritis.
(3) Mesangial proliferative lesions.
(4) Minimal lesions of kidney disease.
(5) focal segmental glomerular sclerosis.
2. Immunofluorescence check:
Immunoglobulin IgG, IgA, IgM and complement C3 are deposited along the glomerular basement membrane in diffuse granular form, sometimes in the mesangial area.
3. Electron microscopy:
In the glomerular basement membrane, electron dense deposits were observed in the mesangial area under the epithelial cells.
Diagnosis
Diagnosis and diagnosis of renal damage in solid tumors
diagnosis
In all kinds of kidney diseases with unknown causes, it is necessary to pay attention to the possibility of excluding tumors, especially in patients with middle-aged or older, sudden onset of kidney disease, more need to be vigilant, some patients may have kidney disease (such as nephrotic syndrome), after The symptoms of tumors should be examined in detail and traced. Hodgkin's disease is a common malignant tumor that causes glomerular lesions, and its differential diagnosis is quite difficult. The diagnosis points are:
1. More common in middle-aged men.
2. The prominent manifestation is superficial lymphadenopathy.
3. Some superficial lymph nodes are not large, while deep lymph nodes are enlarged, invading the lungs, spleen or intra-abdominal lymph nodes.
4. Fever, itchy skin, jaundice, can be a regression heat type.
5. Lymph node pain after drinking.
6. Bone marrow aspiration and lymph node biopsy are helpful for diagnosis.
Diabetic patients with active urinary sediment changes, proteinuria or even nephrotic syndrome, and other systemic diseases, especially connective tissue diseases, are excluded, and kidney damage or nephrotic syndrome should be considered.
Differential diagnosis
1. The differential diagnosis between malignant tumors that are prone to glomerular lesions is quite difficult, such as Hodgkin's disease.
2. Differentiation from glomerular lesions caused by various causes such as urate kidney disease, high calcium kidney disease, hypokalemia, acute renal failure caused by acute hyperuricemia (some tumors during chemotherapy) ), obstructive kidney disease, etc.
