What is the treatment for Melanoma-associated (Malignant Melanoma) glomerulonephritis (Impaired Renal Function)?

From the Guidelines

The treatment of melanoma-associated glomerulonephritis primarily involves addressing the underlying melanoma while managing kidney complications, with the cornerstone of therapy being surgical removal of the melanoma when possible, and immunosuppressive therapy with rituximab or cyclophosphamide for patients with at least one risk factor for disease progression, as recommended by the KDIGO 2021 guideline 1. The goal of treatment is to prevent disease progression, reduce proteinuria, and improve kidney function, while minimizing the risk of adverse effects from immunosuppressive therapy.

• The initial treatment approach should be based on the severity of presenting symptoms and the type of glomerulonephritis, with consideration of the patient's estimated glomerular filtration rate (eGFR) and proteinuria levels 1.
• For patients with melanoma-associated glomerulonephritis, the use of checkpoint inhibitors such as pembrolizumab, nivolumab, or ipilimumab may be necessary for advanced melanoma, but these agents can sometimes cause kidney injury, and their use should be carefully monitored 1.
• Supportive care is essential, including blood pressure control with ACE inhibitors or ARBs, diuretics for fluid overload, and dietary sodium restriction, as well as regular monitoring of kidney function, proteinuria, and electrolytes, with adjustments to therapy as needed 1.
• The prognosis depends largely on the stage and response of the melanoma to treatment, as successful cancer therapy often leads to improvement in kidney manifestations due to the paraneoplastic nature of this condition.
• In patients with resistant disease, consultation with an expert center may be necessary to consider experimental therapies or higher doses of conventional immunosuppressive therapy 1.

From the Research

Treatment of Melanoma-associated Glomerulonephritis

• The treatment of melanoma-associated glomerulonephritis is not well-established, but some studies suggest that immunosuppressive therapy may be effective 2, 3.
• In one case report, a patient with melanoma-associated membranous glomerulonephritis experienced spontaneous regression of nephrotic syndrome after surgical treatment of the melanoma, without specific renal or oncological treatment 2.
• Other studies have investigated the use of immunosuppressive agents, such as cyclophosphamide and glucocorticoids, in the treatment of glomerulonephritis 4, 3, 5.
• A study published in 2019 found that a low-dose glucocorticoid regimen in association with cyclophosphamide was effective in treating glomerulonephritis, with fewer metabolic disorders and infections compared to a traditional oral corticosteroid regimen 4.
• Another study published in 1994 found that an intensive immunosuppressive regimen combining steroids and alkylating agents was effective in inducing remission and halting progression to end-stage renal disease in patients with membranoproliferative glomerulonephritis 3.
• Cyclophosphamide pulse therapy has also been shown to be effective in treating primary glomerulonephritis, with a statistically significant decrease in proteinuria observed in one study 5.
• However, the use of BRAF and MEK inhibitors in the treatment of metastatic melanoma has been associated with glomerulonephritis and granulomatous vasculitis in some cases, highlighting the need for careful monitoring of renal function in patients receiving these therapies 6.