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Malignancy-associated membranous nephropathy: focus on diagnosis and treatment

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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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Availability of data and material

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).

Author information

Author notes

  1. San** Ai and **Wei Yan contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Bei**g, China

    San** Ai, **Wei Yan, XueSong Zhao, WenLing Ye, YuBing Wen, XueMei Li & Yan Qin

  2. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Bei**g, China

    **g Wang & BoJu Pan

  3. Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Bei**g, China

    Jie Dong

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  1. San** Ai
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  9. XueMei Li
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  10. Yan Qin
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Corresponding author

Correspondence to Yan Qin.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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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Informed consent was obtained from all participating patients.

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Supplementary Information

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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)

Supplementary file3 (DOCX 13 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

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