V KHELGI1, 2, S GOVINDARAJULU1, S VENUTHURUPALLI1, 2
1Renal service, Darling Downs Hospital and Health Service, Toowoomba, Queensland; 2Rural School of Medicine, University of Queensland Toowoomba, Queensland
Aim: To retrospectively review the temporal relationship between membranous nephropathy (MGN) and malignancy at DDHHS, Toowoomba.
Background: MGN is associated with malignancy with varying prevalence between 6-20%. There is debate as to how to screen and or investigate for evidence of malignancy in this group. Currently, there are no definite guidelines and age appropriate screening is warranted.
Methods: Retrospective analysis of kidney biopsies performed at DDHHS between 2006 and 2016. Patients with MGN were identified and clinical course including treatment, immunosuppressive medication, rates of remission documented. Evidence of malignancy and its temporal association with MGN noted.
Results: Over a ten year period 216 biopsies were performed of which 20 patients (10.8%) had MGN with mean age of 48.5 years (20-82 years). Of these, eight patients (40%) had evidence of malignancy. Out of these 2 had haematological malignancy, 3 solid organ (colon, lung and breast), 2 unknown primary and 1 invasive BCC.
Four patients were diagnosed with malignancy prior to the biopsy (Average duration 39.7 months) and four patients were diagnosed after the biopsy (Average duration 6.7 months). Mean age in patients with malignancy is significantly higher (63.0 Vs 38.2 yrs).
Four achieved complete remission (3 standard therapy including surgery in 1, steroids only in 1). Two had partial remission (1 cyclophosphamide + Steroids followed by rituximab and 1 only RTX). Two non responders died due to malignancy related complications.
Conclusions: Higher prevalence (40%) of malignancy was noted in older patients with biopsy proven MGN. Although age appropriate investigations are indicated in these patients, it may be prudent to actively look for evidence of malignancy especially in elderly population given the concerns associated with immunosuppressive therapies.