Abstract
Background
The clinicopathological features of malignancy-associated membranous nephropathy have been described previously, but information about diagnosis and treatment remains limited.
Methods
Patients with malignancy-associated membranous nephropathy in a tertiary hospital in China between June 2012 and October 2021 were retrospectively reviewed.
Results
Forty-two patients with malignancy-associated membranous nephropathy were identified. Compared to patients with idiopathic membranous nephropathy, patients with malignancy-associated membranous nephropathy were older and less frequently showed glomerular phospholipase A2 receptor staining (37.9% vs 85.0%) and IgG4 predominant deposition (66.7% vs 95.0%). At diagnosis of membranous nephropathy, the malignancy was unknown in 67% (28/42) of patients and was detected only by tumor screening. Among the 19 patients with concurrent diagnosis of cancer and biopsy-proven membranous nephropathy, 15 received anticancer treatment alone initially. Six of the 10 patients who attained cancer remission achieved remission of membranous nephropathy, while none of the 5 patients without remission of cancer did, suggesting a causal relationship between the two diseases. Some patients with persistent or relapsing membranous nephropathy following cancer remission achieved remission of membranous nephropathy after immunosuppressive therapy. Over a median follow-up of 24 months, 25% (10/40) of patients died, mainly due to neoplasia.
Conclusions
Tumor screening is important in patients with membranous nephropathy, especially in elderly patients and patients with negative phospholipase A2 receptor or non-IgG4 predominant deposition. Remission of membranous nephropathy can be observed following remission of cancer in some cases. Immunosuppressive therapy may be considered if membranous nephropathy does not remit after remission of cancer.
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The data in the current study are available from the corresponding author on reasonable request.
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Funding
This work was supported by the National Natural Sciences Foundation of China Grants (81970621 to Dr. Qin).
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The study was approved by the Institutional Review Board of Peking Union Medical College Hospital (S-K2073). Patient data were anonymously used under consideration of the latest version of the Helsinki Declaration of human research ethics.
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40620_2023_1751_MOESM1_ESM.jpg
Supplementary file1 Fig. S1. Treatment and outcome of the 6 patients with simultaneous diagnosis of cancer and MN (not biopsy-proven). IST indicates immunosuppressive therapy. (JPG 133 KB)
40620_2023_1751_MOESM2_ESM.jpg
Supplementary file2 Fig. S2. Treatment and outcome of the 4 patients with cancer discovered after the diagnosis of MN (not biopsy-proven). IST indicates immunosuppressive therapy. (JPG 138 KB)
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Ai, S., Yan, X., Zhao, X. et al. Malignancy-associated membranous nephropathy: focus on diagnosis and treatment. J Nephrol 36, 2355–2363 (2023). https://doi.org/10.1007/s40620-023-01751-4
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DOI: https://doi.org/10.1007/s40620-023-01751-4