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Kidney Week

Abstract: PO1867

Renal Pathology in Cancer Patients in a New Era of Treatments

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Bolufer, Mónica, Vall Hebron, Barcelona, Barcelona, Spain
  • García-Carro, Clara, Hospital Clinico San Carlos, Madrid, Madrid, Spain
  • Soler, Maria Jose, Vall Hebron, Barcelona, Barcelona, Spain

Group or Team Name

  • On behalf of the GLOSEN/ONCONEFROLOGÍA.
Background

Classically patients with metastatic cancer were not submitted to invasive procedures because of their short life expectancy.Kidney biopsy(KB) is an especially useful diagnostic and prognostic tool in these patients when they develop kidney injury.The aim of our study is to assess clinical and histological characteristics of patients with active solid organ malignancy that underwent KB in a multicenter cohort

Methods

We performed a multicenter collaborative study.Clinical, demographical and histological date from patients with an active neoplasia or in active cancer treatment who underwent KB were collected. We studied the follow-up of the patients in terms of renal function and survival.

Results

124 patients with cancer who underwent KB during the study period from 11 hospitals were included.63.7% men, mean age 67(SD ±10.28) years old. The indications of KB were acute renal failure (56.6%), proteinuria (20.2%) and exacerbation of CKD (15.3%). At the time of the KB, 30.6% patients presented diabetes and 63.7% high blood pressure. Malignancies: lung (30.6%),intestinal (27.4%),melanoma (7.3%) and genitourinary(17.7%), with 44.3% metastatic cancer
Oncoespecific treatment:35.5% received chemotherapy,31.4% immunotherapy (of which 26.3% received more than 1 checkpoint inhibitor), 24.2% specific therapies and 3.2% conservative treatment
Baseline renal function before KB,16.1% presented Cr>1.5mg/dL. At the time of KB, mean Cr 2.54mg/dL ([1,7-3,9 (IQ 25-75)], urine protein/Cr ratio 895mg/g[275-2610(IQ 25-75)] and 53.2% hematuria
KB diagnosis:35.5% acute interstitial nephritis (AIN), acute tubular necrosis(8.9%) and IgA nephropathy(8.1%).65% of patients received corticosteroids for an average of 4.8 months[SD ± 3,9].20.2% required kidney replacement therapy and 36.3% presented Cr>1.5mg/dL at 3 months. Average follow-up 16.23[5.5-32,8(IQ 25-75)] months and 37.9% died at the end of follow-up
Metastatic cancer at the moment of KB was identified as an independent risk factor for mortality (p=0.012)

Conclusion

Currently, AIN is the first cause of kidney injury in biopsied patients with active cancer.This is followed by thrombotic microangiopathy, membranous nephropathy and IgA among others.KB in this group of patients provides valuable diagnostic and prognostic information.More studies are needed to expand the consensus in the diagnosis and treatment of oncological patients with renal injury