Quantification of cancer risk in glomerulonephritis

Abstract

BackgroundThe association of increased cancer risk with glomerulonephritis (GN) is well known, but controversy exists concerning which types of GN are involved, and the size of the association. A national registry survey was performed to assess the size of this association, and the temporal relationship of cancer diagnosis to GN diagnosis.MethodsAll patients with biopsy-proven GN between 1985 and 2015 in Denmark were extracted from The Danish Renal Biopsy Registry and the National Pathology Data Bank. Incident cancer diagnoses between 10 years previous and 10 years subsequent to the GN diagnosis were extracted from the Danish Cancer Registry. Residence, birth and death data were obtained from the National Patient Register. Expected cancer incidence, classified according to cohort, age and sex were extracted from the Nordcan database.ResultsNine hundred eleven cancers were diagnosed in 5594 patients. Thirty five percent were prevalent at renal biopsy. Prevalence at biopsy was 5.5% (expected 3.1%), but incidence was not increased < 1 year before biopsy. Increased cancer rates were seen for GN forms: minimal change, endocapillary, focal segmental glomerulosclerosis, mesangioproliferative, membranous, focal segmental, membranoproliferative, proliferative, ANCA-associated vasculitis, lupus nephritis and unclassified. Increased cancer rates were seen for lung, prostate, renal, non-Hodgkin lymphoma, myeloma, leukaemia and skin. The increased incidence was mainly limited to − 1 to 1 year after biopsy, but skin cancer showed an increased risk over time. Some diagnoses showed an increase 5–10 years after biopsy. Incidence was raised for patients with uraemia and nephrosis, but less for proteinuria or haematuria. Cancers in patients < 45 years were rare. The risk of developing cancer 0–3 years after biopsy for patients 45–64 years varied from 7.3% (minimal change) to 15.8% (unclassified GN); > 64 years from 11.8 (endocapillary GN) to 20.3% (unclassified). The diagnosis with the highest risk was membranoproliferative GN (8.6 & 19.6%).ConclusionsCancer rates are increased for many cancer and most GN diagnoses. Cancer screening for patients < 45 years and for patients without nephrosis or uraemia may not be necessary. The findings suggest that screening programs for specific GN diagnoses can be extended to other GN forms.

Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers

“…Moreover, there is uncertainty about what outcomes of the disease and its treatment are most important to patients. Patients with glomerular disease may experience kidney failure (1,2), bone disease (3), cancer (4)(5)(6), infertility (7,8), fatigue, swelling (9)(10)(11), impaired psychosocial wellbeing (9,11,12), and reduced life expectancy (13)(14)(15). In weighing treatment options, decision makers require comprehensive information about all relevant harms and benefits.…”

Hypertensive nephropathy is associated with an increased risk of myeloma, skin, and renal cancer

“…24,35 Uremia is characterized by general immune dysfunction. 36 Since this is a recognized cause of skin cancer, 37 the incidence of which was raised both in this study and in glomerulonephritis, 38 this suggests that uremia may play a causative role in the development of skin cancer. Furthermore, ESRD is related to increased cancer risk, 39,40 possibly secondary to secondary degenerative cystic kidney disease.…”

“…Another explanation for the simultaneous diagnosis of hypertensive nephropathy and cancer could be causal, either clinical cancer leading to a clinical exacerbation of hypertensive nephropathy, or increasing renal disease leading to an acceleration of subclinical cancer, due for example, to a concomitant reduction in immune capacity. A recent study of the incidence of cancer related to glomerulonephritis using the same database showed a similar pattern, though with a different distribution of cancer diagnoses, suggesting that it the renal dysfunction per se, rather than the etiology of the renal disease that is related to the cancer. Another explanation is that some patients with cancer and hypertensive nephropathy may have died before reaching a point where renal biopsy is indicated; however, this would not explain the post‐biopsy fall in incidence.…”

“…The increase in cancer incidence around the time of renal biopsy may be incidental, due to increased attention to possible cancer in patients with renal problems, or vice versa. 42 However, one study showed no significant increased risk A recent study of the incidence of cancer related to glomerulonephritis using the same database 38 showed a similar pattern, though with a different distribution of cancer diagnoses, suggesting that it the renal dysfunction per se, rather than the etiology of the renal disease that is related to the cancer. Another explanation is that some patients with cancer and hypertensive nephropathy may have died before reaching a point where renal biopsy is indicated; however, this would not explain the post-biopsy fall in incidence.…”

Cancer Development and Mortality Differences in Patients with Glomerulonephritis after Renal Biopsy: A Single Center Retrospective Cohort Study

“…From our results, the four most common cancer types were colon cancer, hepatocellular carcinoma, papillary thyroid carcinoma, and gastric cancer, all of which are among the six major cancers affecting the general Korean population [21]. These common cancer types differ from those reported in previous reports from Western countries, wherein the greatest increases were observed for non-Hodgkin's lymphoma and skin cancer in the GN population relative to the general population [10,17,22]. The finding of the present and previous studies emphasize that screening for de novo cancer during the follow-up period after GN diagnosis should include cancers that occur most often in the corresponding general population.…”