From the Research
Steroids can help in treating melanoma-associated glomerulonephritis, as evidenced by a case report where a patient's renal function stabilized with oral cyclophosphamide and pulse intravenous methylprednisolone followed by oral prednisone 1.
Treatment Approach
The primary treatment involves addressing the underlying melanoma through surgical removal, immunotherapy, or targeted therapy, as the glomerulonephritis is often a paraneoplastic manifestation.
- For the kidney inflammation itself, corticosteroids such as prednisone (starting at 1 mg/kg/day, typically 60-80 mg daily) are commonly used to reduce inflammation and immune complex deposition in the glomeruli.
- This treatment is usually continued for several weeks with gradual tapering based on clinical response.
- In more severe cases, additional immunosuppressive medications like cyclophosphamide or rituximab may be added.
Monitoring and Prognosis
Regular monitoring of kidney function through blood tests (creatinine, BUN) and urine analysis is essential during treatment.
- Steroids work by suppressing the immune response that damages the kidney's filtering units, but they don't address the underlying cancer that triggers this immune reaction.
- The prognosis depends largely on successful treatment of the melanoma, as resolution of the cancer often leads to improvement in kidney function, as seen in a case where a patient's nephrotic syndrome regressed rapidly following surgical treatment of the melanoma 2.
Additional Considerations
It's also important to note that BRAF and MEK inhibitors, used in the treatment of metastatic melanoma, can be associated with kidney adverse events, including glomerulonephritis 3.
- In such cases, withdrawal of the offending medication and initiation of immunosuppressive therapy may be necessary to improve renal function.
- The use of extracorporeal immunoadsorption, prednisolone, and cyclophosphamide has also been reported to be beneficial in treating rapidly progressive glomerulonephritis 4.
- Long-term benefits of therapy with cyclophosphamide and prednisone have been observed in patients with membranous glomerulonephritis and impaired renal function 5.