Young adults with glomerular disease at increased risk of cancer

Glomerular disease is associated with an increased risk of cancer, particularly among younger patients who are typically excluded from screening programs, according to a retrospective study.

Researchers used data from a centralized pathology registry in British Columbia in Canada and identified adults with a diagnosis of glomerular disease, including IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease, lupus nephritis, and ANCA-associated glomerulonephritis.

All-cause cancer, excluding nonmelanoma skin cancer, was examined in relation to known risk factors such as age, sex, ethnicity, smoking, alcohol abuse, obesity, diabetes, dyslipidaemia, hypertension, and cardiovascular disease, as well as glomerular disease type, estimated glomerular filtration rate (eGFR), and level of proteinuria.

A total of 4,039 patients were included in the analysis (mean age 51 years, 52 percent male). Over a median follow-up of 7.8 years, de novo cancer occurred in 384 patients (9.5 percent).

The 20-year cancer risk in patients with glomerular disease was 23 percent, with the incidence rate higher by 30 percent compared with that observed in the general population (standardized incidence ratio [SIR], 1.3, 95 percent confidence interval [CI], 1.2–1.4). Cancer risk was especially pronounced in patients under 40 years of age, almost threefold higher than that in the general population (SIR, 2.9, 95 percent CI, 1.6–4.6).

With regard to cancer type, significant increases were observed for lymphoma (SIR, 3.5), kidney (SIR, 2.6), colorectal (SIR, 2.4), and lung cancers (SIR, 1.5). Cancer risk was elevated both before and after the onset of end-stage kidney disease.

Independent predictors of cancer risk among patients with glomerular disease included age, male sex, baseline eGFR, and glomerular disease type.

The findings underscore the need to raise awareness of cancer risk among patients with glomerular disease, especially those in the younger age groups, and may inform the further development of tailored cancer screening and prevention strategies, according to the researchers.