Kidney Week 2025 Annual Meeting-Proteinuria and Hypertension in Patients with Cancer

Video Transcription

Video Summary

This clinical practice session focused on proteinuria and hypertension in patients with cancer, emphasizing paraneoplastic glomerular disease and treatment-related kidney injury. Speakers reviewed how malignancy can trigger glomerular damage indirectly—likely through tumor antigens, cytokines, and immune activation—though prevalence remains uncertain due to limited systematic screening and reporting bias. Membranous nephropathy is the most commonly reported paraneoplastic glomerulopathy, with higher cancer association in older patients and in cases lacking IgG4 dominance or involving certain antigens (e.g., THSD7A, NELL1). Other malignancy-associated patterns discussed included minimal change disease (notably with Hodgkin lymphoma and thymoma), FSGS, IgA nephropathy, MPGN (often with CLL), anti-GBM disease, and AA amyloidosis (notably with RCC).<br /><br />A second talk addressed management of cancer therapy–associated proteinuria, highlighting VEGF inhibitors and TKIs as common causes (proteinuria incidence 21–63%, nephrotic syndrome 2–6%). Prevention includes baseline BP/proteinuria assessment, ACEi/ARB use, and close monitoring. Emerging adjuncts include SGLT2 inhibitors (evidence largely extrapolated from CKD/diabetes trials and case reports, including one case enabling continued lenvatinib) and GLP-1 receptor agonists (albuminuria reduction in diabetes/CKD trials; limited cancer-specific data).<br /><br />Complement activation in drug-induced thrombotic microangiopathy (TMA) was reviewed, particularly with gemcitabine, VEGF inhibitors, and proteasome inhibitors. Plasmapheresis is often ineffective; complement inhibition (eculizumab) shows promising case-series evidence for hematologic and partial renal recovery and may allow rechallenge of essential cancer therapy in select cases.<br /><br />Finally, hypertension from hormonal therapies was discussed: abiraterone can cause mineralocorticoid excess–like hypertension and hypokalemia (real-world rates up to ~40%); management may include amiloride/eplerenone (avoid spironolactone). Aromatase inhibitors may also worsen BP via estrogen depletion mechanisms. The session emphasized multidisciplinary care and routine cancer and kidney screening.

Asset Subtitle

Moderator(s): Shruti Gupta, Abhijat Kitchlu

Presentation(s):

Paraneoplastic Glomerular Diseases in Patients with Cancer Leading to Proteinuria and Hypertension - Sabine Karam
Management of Proteinuria in Patients with Cancer: Benefits of SGLT2 Inhibitors and GLP-1 Receptor Agonists - Swetha Rani Kanduri
Complement Activation in TMA and Potential Benefits of Complement Inhibition in Patients with Cancer - Sandra Herrmann
Managing the Pressure: Hypertension from Hormonal Therapies in Cancer - Prakash Gudsoorkar

Meta Tag

Date 11/8/2025

Pathway 1 Onconephrology

Pathway 2 Hypertension and Cardiorenal Disorders

Session ID 504338

Keywords

proteinuria in cancer

paraneoplastic glomerular disease

membranous nephropathy

THSD7A

NELL1

minimal change disease

focal segmental glomerulosclerosis (FSGS)

IgA nephropathy

membranoproliferative glomerulonephritis (MPGN)

VEGF inhibitors

tyrosine kinase inhibitors (TKIs)

drug-induced thrombotic microangiopathy (TMA)

eculizumab