MO288NEPHROTIC SYNDROME AS A PARANEOPLASTIC ENTITY: ARE WE KEEPING IT IN MIND?
Authors: Aiffil Meneses Arianne , García Carro Clara , Valencia Nancy Daniela , Valdés Franci Elena , Sánchez de la Nieta Mª Dolores , Velo Mercedes , Rodríguez-Moreno Antolina , Ruiz Elena , Domínguez Delgado-Palacios Jesús , Sánchez-Fructuoso Ana I 
Published: May 2021

Abstract

Background and Aims
Association between nephrotic syndrome (NS) and cancer is well known. However, it has been barely studied and scarcely sustained. Membranous nephropathy (MN) has been identified often as a glomerular paraneoplastic disease. Reported incidence of cancer at the time of biopsy or one year follow-up of MN is 10-20%. Incidence rates in other glomerulopathies are limited. Concomitant malignancy is associated with poor renal outcome in NS. Therapy for cancer is priority and immunosuppressives therapies should be restricted. Furthermore, there is no consensus for cancer screening in patients with NS with or without known risk factors for cancer, as smoking or alcohol consumption.
The aim of our study is to stablish the incidence of neoplasia in a cohort of patients of a tertiary hospital of Spain who develop NS. We analyze clinical characteristics, glomerular disease, type of malignancies, screening procedures and risk factors for cancer in this population.

Method
All patients with NS at our center between January 2013 and December 2019 were included. Demographical and clinical data, and laboratory results were collected, as well as all tests performed for cancer screening. Patients who presented cancer the year before or 24 months after the diagnosis of NS were identified. We performed a logistic regression model to identify independent risk factors for cancer in this population.

Results
During the study period, 47 patients presented with NS at our center. 38.3% were women and mean age was 57.28±17.3 years. 46.8% patients presented high blood pressure and 23.4% type 2 DM. 5 patients presented HIV infection, and 4 hepatitis C. 51% reported smoking, and 19% of alcohol consumption. Mean creatinine at NS diagnosis was 2.48±2.30 mg/dL, and proteinuria 10.9±6.7 g per day. Histologic diagnosis were: MN (n=7), membranoproliferative glomerulonephritis (n=5), diabetic nephropathy (n=5), and focal and segmental glomerulosclerosis (n=4). 9 out 47 patients presented cancer: 6 patients had a malignancy diagnosed the year before the NS onset (prostate carcinoma n=2, gastrointestinal carcinoma n=2, lung carcinoma n=1, and Hodgkin lymphoma n=1), and 3 patients one the year after the NS onset (thyroid carcinoma n=1, melanoma n=1, and multiple myeloma n=1). In the univariate analysis, patients with cancer were older (69.3±12.1 vs 54.4±17.2 years old, p=0.018) and had more frequently alcohol consumption (33.3% vs 15.8%, p=0.0187). There were no differences in terms of smoking, viral infections, renal function, proteinuria or type of glomerulopathy. In multivariate analysis including these two variables and gender, neither age nor alcohol intake were a risk factors for the presence of cancer in patients with NS.

Conclusion:
19.1% patients with NS presented also concomitant cancer in our cohort, without association to the type of glomerulopathy, age or known risk factors for neoplasia such as alcohol, tobacco or viral infection. As our data showed, the presence of cancer in patients with NS is considerable, so the development of screening strategies to find occult malignancies in this group of patients is necessary since this condition compromises renal outcome and life expectancy