Abstract: FR-PO0814
Cancer-Associated Membranous Nephropathy: A 30-Year Single-Center Cohort Study
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Lepori, Nicola, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
- Angioi, Andrea, Azienda Ospedaliera Brotzu, Cagliari, Sardinia, Italy
- Piras, Doloretta, Azienda Ospedaliera Brotzu, Cagliari, Sardinia, Italy
- Floris, Matteo, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
- Bianco, Paola, Azienda Ospedaliera Brotzu, Cagliari, Sardinia, Italy
- Cabiddu, Gianfranca, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
- Pani, Antonello, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
Background
The link between membranous nephropathy (MN) and malignancy remains difficult to establish in the antigen-defined era. We assessed prevalence, features, outcomes, and predictors of cancer-associated MN
Methods
We retrospectively reviewed adults with MN followed at ARNAS G. Brotzu Hospital, Cagliari, Italy, from January 1995 to June 2025. Patients with incomplete baseline or follow-up data were excluded. Clinical, laboratory, histologic, PLA2R, cancer timing, treatment, and renal outcome data were collected. Cancer-associated MN was defined as cancer diagnosed within 12 months before or after MN diagnosis and compared with all other MN cases.
Results
Among 252 MN cases, 218 were included. Mean age was 53.9+/-17.3 years, 63.8% were male, 86% had nephrotic syndrome, mean proteinuria was 7.9+/-4.3 g/day, and mean eGFR was 81.7+/-31.0 mL/min/1.73 m2. MN was biopsy-proven in 87.6%; PLA2R-associated MN was identified in 74.6% of tested patients (103/138). Overall, 5% had a previous cancer history and 12% developed cancer during follow-up. Twelve patients had cancer within +/-12 months of MN diagnosis. Compared with other MN cases, these patients were older (67.4 vs 53.2 years, p=0.003), had lower creatinine clearance (76.1 vs 98.8 mL/min, p=0.029), and lower serum albumin (2.3 vs 2.6 g/dL, p=0.035). PLA2R positivity was similar (72.7% vs 74.7%), as were histologic stage and mesangial proliferation. Cancer-associated MN was managed more often conservatively (66.7% vs 11.7%, p<0.001) and showed poorer outcomes, with higher nonresponse after first treatment (41.7% vs 17.5%, p<0.01) and at last follow-up (33.3% vs 17.5%, p=0.03). Radical cancer treatment was achieved in 7/12 patients, but MN remission after cancer treatment alone occurred in 3/12. Older age, lower albumin, and prior cancer history were independently associated with cancer-associated MN.
Conclusion
In this long-term MN cohort, temporally cancer-associated MN was uncommon but clinically distinct, occurring in older patients with more severe nephrotic features and worse renal response. Similar PLA2R positivity and histology suggest that PLA2R status alone may not exclude cancer association. Age, hypoalbuminemia, and cancer history may help guide malignancy screening in MN.