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Malignancy in Membranous Nephropathy: Evaluation of Incidence
Basil Alnasrallah1, John F Collins1, L Jonathan Zwi2
1Department of Nephrology, Auckland City Hospital, 2 Park Drive, Grafton, Auckland 1023, New Zealand.
Background:
Membranous nephropathy (MN) can be associated with malignancy. However, the relative risk for malignancy remains unclear. It has been reported that higher numbers of inflammatory cells seen in the glomeruli at biopsy correlate with the occurrence of malignancy in patients with MN and might be used to direct screening.
Methods:
We examined the occurrence of malignancy in 201 MN patients in Auckland, New Zealand. We also examined the pathology of renal biopsies from 17 MN patients with malignancies and compared the number of inflammatory cells per glomerulus with matched control patients with MN but no malignancy.
Results:
40 malignancies were identified in 37 patients, 28 of which occurred after the MN diagnosis. The standardized incidence ratio (SIR) was 2.1 (95% CI, 1.3-2.85) which was similar between patients ≥ 60 years and those <60 years. The median number of inflammatory cells per glomerulus did not differ between MN patients with and without malignancy at 1.86 (IQR, 1.17-2.7) and 2.07 (IQR, 1.17-3.65), respectively (p value 0.56).
Conclusions:
The relative risk of malignancy in MN patients was similar across different age groups. The number of inflammatory cells per glomerulus did not differentiate between MN patients with and without malignancies.
Insights
Patients with membranous nephropathy (MN) have a doubled risk of malignancy. However, the number of inflammatory cells in kidney biopsies does not predict cancer risk in MN patients.
Area of Science:
- Nephrology
- Oncology
- Pathology
Background:
- Membranous nephropathy (MN) is linked to an increased risk of malignancy, but the precise risk and predictive factors are not fully understood.
- Previous research suggested a correlation between glomerular inflammatory cell counts and malignancy in MN patients, potentially aiding screening.
- The association between MN and cancer risk requires further investigation to guide clinical practice.
Purpose of the Study:
- To determine the relative risk of malignancy in patients diagnosed with membranous nephropathy.
- To investigate whether the number of inflammatory cells in renal biopsies can predict malignancy in MN patients.
- To assess if age influences the risk of malignancy in individuals with MN.
Main Methods:
- A cohort study of 201 membranous nephropathy patients in Auckland, New Zealand, was conducted to track malignancy occurrence.
- Renal biopsy pathology from 17 MN patients with confirmed malignancies was analyzed.
- The number of inflammatory cells per glomerulus was compared between MN patients with and without malignancy.
Main Results:
- A total of 40 malignancies were identified in 37 patients, with 28 diagnosed after the initial MN diagnosis.
- The standardized incidence ratio (SIR) for malignancy in MN patients was 2.1 (95% CI, 1.3-2.85), indicating a significantly increased risk.
- No significant difference was observed in the median number of inflammatory cells per glomerulus between MN patients with (1.86) and without (2.07) malignancy (p=0.56).
Conclusions:
- The overall risk of developing cancer is elevated in patients with membranous nephropathy.
- The number of inflammatory cells within glomeruli on biopsy does not serve as a reliable indicator for predicting malignancy in MN patients.
- The increased risk of malignancy associated with MN was consistent across different age demographics.
