MO052: New Trend in the Diagnosis of Kidney Disease in Cancer Patients: A Multicenter Study

Abstract

BACKGROUND AND AIMS The new advances in cancer treatments and the increasing prevalence of kidney disease in the population with cancer have extended the indication of kidney biopsies. The purpose of the study is to analyze clinical and histological characteristics of patients with active solid organ malignancy that underwent kidney biopsy. METHOD Multicenter collaborative retrospective registered study supported by two working groups GLOSEN/Onconephrology from the Spanish Society of Nephrology. Clinical, demographical and histological data were collected. Comparison of continuous variables between two groups was performed by Student’s T-test, and Cox survival analysis adjusted for clinical conditions was performed to identify risk factors associated with mortality. RESULTS A total of 148 patients with cancer who underwent a kidney biopsy from 12 hospitals were included. About 64.3% men and mean age 66.9 years old. The indications for biopsy were acute renal failure (67.1%), proteinuria (17.1%) and acute on top of chronic kidney disease (8.2%). The most frequent malignancies were lung (29.1%) and abdominal (25%), with 49.7% metastatic cancer. As oncospecific treatment, 28.3% received chemotherapy, 29.9% immunotherapy, 19.3% specific therapies and 2.1% conservative treatment (Figure 1) At the time of kidney biopsy, median creatinine was 2.58 mg/dL [1.81–4.1(IQ 25–75)], median urine protein/creatinine, 700 mg/g [256–2463 (IQ 25–75)] and 53.1% presented hematuria. The renal biopsy diagnosis most frequent was acute interstitial nephritis (39.9%), followed by acute tubular necrosis (8.8%) and IgA nephropathy (7.4%). Acute interstitial nephritis was more frequent in the period from 2017 to 2021 as compared with the period from 2010 to 2016 (P = 0.001). About 67.1% received corticosteroids and 18.9% required kidney replacement therapy. Median follow-up was 15.2 months [5.7–31.4 (IQ 25–75)]. The only factor associated with mortality was the presence of the metastasis at the time of kidney biopsy (P = 0.006). CONCLUSION There is a new trend in kidney disease and patients with cancer in terms of diagnosis and treatment. At present, acute interstitial nephritis has consolidated as the most common kidney pathology in this population. Renal biopsy is valuable tool for diagnosis, treatment and prognosis of solid organ cancer patients with kidney damage.