Abstract
BackgroundThe association between glomerulonephritis (GN) and cancer has been well known for decades. However, studies evaluating long-term de novo cancer development in patients with GN are limited. This study aimed to evaluate the incidence of cancer development among patients with renal biopsy-proven GN during post-biopsy follow-up and the differences in outcomes according to cancer occurrence.MethodsWe conducted a retrospective cohort study of adult patients who underwent renal biopsy at Seoul National Bundang Hospital between 2003 and 2017. After excluding 778 patients with age < 18 years, cancer diagnosis before or within 6 months after renal biopsy, immunosuppressant therapy before renal biopsy, or pathologic diagnoses other than GN, 822 patients were included in the analysis. Data on baseline clinical characteristics, renal biopsy results, and types and doses of immunosuppressant agents were collected from electronic medical records. The incidence of cancer was censored on the date when the first cancer was diagnosed. We evaluated rates of mortality and end-stage renal disease (ESRD) development during follow-up.ResultsDuring a mean follow-up period of 58.9 ± 44.5 months, 45 subjects (5.5%) developed de novo cancer. A comparison of clinical characteristics between subjects who did and did not develop cancer revealed that cancer patients were older and had higher comorbidities and immunosuppressant use. Overall, patients with GN had an elevated standardized incidence ratio (SIR) of 7.16 (95% confidence interval (CI): 5.22–9.61) relative to the age- and sex-matched general population. In particular, the SIR was significantly higher in GNs such as membranous nephropathy (MN), IgA nephropathy, lupus nephritis, and focal segmental glomerulosclerosis. Multivariable Cox proportional hazard model revealed that patients with MN had an increased risk of cancer development, with a hazard ratio of 2.30 [95% CI: 1.06–4.98]. Patients with MN who developed cancer had a significantly higher risk of mortality (hazard ratio: 6.59; 95% CI: 1.22–35.56, P = 0.03) than those without cancer, but there was a non-significant difference in ESRD development. Conclusions: Patients with GN without concurrent cancer, particularly those with MN, have significantly higher risks of cancer development and subsequent mortality and should remain aware of the potential development of malignancy during follow-up.
Highlights
The association between glomerulonephritis (GN) and cancer has been well known for decades
The standardized incidence ratio (SIR) was significantly higher in GNs such as membranous nephropathy (MN), IgA nephropathy, lupus nephritis, and focal segmental glomerulosclerosis
When the SIR was calculated according to specific GN types, subjects with lupus nephritis (SIR: 39.46, 95% Confidence interval (CI): 7.93–129.29), crescentic GN (SIR: 10.06, 95% CI: 1.13–43.68), MN (SIR: 8.92, 95% CI: 4.44–16.30), tubulointerstitial injury (TIN) (SIR: 8.82, 95% CI: 1.77– 28.89), diabetic nephropathy (SIR: 8.31, 95% CI: 2.24– 23.07), focal segmental glomerulosclerosis (FSGS) (SIR: 7.73, 95% CI: 2.49–19.17), and immunoglobulin A nephropathy (IgAN) (SIR: 6.05, 95% CI: 3.12–10.77) had increased risks of cancer relative to the general population, the lack of significant differences for other types of GN might have been due to the small numbers of analyzed subjects
Summary
The association between glomerulonephritis (GN) and cancer has been well known for decades. Studies evaluating long-term de novo cancer development in patients with GN are limited. Membranous nephropathy (MN) is the major type of GN, which is associated with a 5-fold higher prevalence of malignancy relative to the reference population [5]. This finding highlights the need to screen for malignancies in patients with GN, in older patients, at the time of diagnosis and during the follow-up period [4, 6, 7]. There have been a few reports that have described an association between GN and the long-term incidence of cancer [10, 17, 18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
