Clinical, laboratory, and morphological characteristics of kidney damage in lymphoproliferative disorders

Джумабаева, Б. Т.; Бирюкова, Л С; Варшавский, В А; Марьина, С. А.; Рощина, Л. С.; Джулакян, У. Л.; Столяревич, Е. C.

doi:10.17650/1818-8346-2017-12-1-44-54

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Морфологически выявляются лимфоидная инфильтрация, гломерулопатии, AL-амилоидоз, тромботическая микроангиопатия. Не исключается роль парапротеина, СЛЦ, криоглобулинов в генезе нефропатии при лимфомах [16]. Реже в результате аутоиммунного поражения при злокачественных лимфомах возможно развитие гломерулонефрита без парапротеинемии и криоглобулинемии [17].…”

Section: фундаментальные исследования в практической медицине на соврunclassified

The role of paraproteins in kidney damage in patients with lymphoproliferative diseases

Pysarevskaya¹,

Kotelnikova²,

Kazakov³

et al. 2019

Onkogematologiâ

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Background. The course of lymphoproliferative diseases, in which the proliferation of a malignant clone is accompanied by the secretion of paraproteins, is often complicated by kidney damage. Perhaps kidney damage is associated with the physicochemical properties of monoclonal proteins.The objective of the study was to determine the relationship between the type of monoclonal paraprotein, its level of secretion, and kidney damage in lymphoproliferative diseasesMaterials and methods. A retrospective analysis of the data of 108 patients with lymphoproliferative diseases accompanied by paraproteinemia and kidney damage was performed. The age of the patients was 31–86 years (median 62.5 years). 78 out of 108 patients were diagnosed with chronic kidney disease (CKD). CKD was diagnosed in accordance with the clinical guidelines of KDIGO 2012.Results. In patients with multiple myeloma, stage III CKD was diagnosed in 28 (35.9 %) cases, stage IV – in 14 (17.9 %), stage V – in 19 (24.4 %). High risk group for CKD included 10 (9.3 %) of 30 patients without CKD. 91 patients were diagnosed with concomitant diseases predisposing to the development of kidney damage. In the group of patients with paraproteinemic hemoblastosis in combination with CKD, the vast majority were patients with the presence of IgGκ and IgGλ blood paraproteins, free light chains (FLC), and Bence-Jones protein (BJ) in the urine. At the same time, patients with the secretion of IgDλ, IgAλ, IgAκ and IgMκ paraproteins were much less common. The highest level of pathological Ig of all classes and their structural components and fragments was observed in patients with stage III CKD, which is also characteristic of other laboratory markers in CKD. A negative correlation of glomerular filtration rate (GFR) with FLCκ in the blood (r = –0.21), GFR with BJκ (r = –0.35), GFR with FLCλ in the blood (r = –0.13), GFR c BJλ, which indicates a tendency to damage the kidneys of FLC and protein BJ.Conclusion. In patients with lymphoproliferative diseases accompanied by monoclonal secretion of paraprotein and kidney damage with the development of CKD, in most cases IgGκ, IgGλ, FLCκ and FLCλ were determined in the blood, and protein BJ in urine. IgAκ, IgAλ, IgMκ, IgMλ, IgDλ paraproteins were determined much less frequently in serum. The highest level of pathological Ig and their structural components was observed in patients with stage III CKD. No association with quantitative level, type of paraprotein, and kidney damage was found. The role of FLC and BJ protein in the development of nephropathy is noted. The results of the study also show that with the development of the disease and kidney damage with subsequent progression of the stage of CKD in patients with lymphoproliferative diseases and proteinemia, there is a tendency to a temporary decrease in proteinuria and a compensatory increase in the number of paraproteins in the blood. This can be considered as one of the compensatory pathophysiological mechanisms of the protective function of the kidneys.

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Section: фундаментальные исследования в практической медицине на соврunclassified

The role of paraproteins in kidney damage in patients with lymphoproliferative diseases

Pysarevskaya¹,

Kotelnikova²,

Kazakov³

et al. 2019

Onkogematologiâ

View full text Add to dashboard Cite

show abstract

“…Морфологически выявляется лимфоидная инфильтрация, гломерулопатии, AL-амилоидоз, тромботическая микроангиопатия. Не исключается роль парапротеина, СЛЦ, криоглобулинов в генезе нефропатии при лимфомах [14]. Реже, при злокачественных лимфомах возможно развитие гломерулонефрита без парапротеинемии и криоглобулинемии, в результате аутоиммунного поражения [15].…”

Section: оригинальные статьиunclassified

The correlation between the level of secretion and the type of monoclonal paraprotein and kidney damage in lymphoproliferative disorders

Pisarevskaya

Kotelnikova

Kazakov

et al. 2019

Russian Medical and Social Journal

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Introduction. The course of lymphoproliferative diseases accompanied by the secretion of paraproteins is complicated by damage to the kidneys and the development of renal failure. There is a pathogenetic relationship between the physicochemical properties of monoclonal proteins and renal pathology. Objective: to find out the relationship between the type of monoclonal paraprotein, the level of its secretion and the degree of renal failure in lymphoproliferative diseases. Patients and methods. We analyzed 108 patients with lymphoproliferative diseases in whom secretion of paraprotein was detected. Age from 31 to 86 years (median 62.5 years). Chronic kidney disease (CKD) was diagnosed in 78 out of 108 patients. Results. CKD was diagnosed in patients with multiple myeloma. Stage III CKD was diagnosed in 28 (35.9%) patients, stage IV - in 14 (17.9%), stage V - in 19 (24.4%). 91 patients were diagnosed with concomitant diseases predisposing to the development of renal pathology. In the blood serum of patients with paraproteinemic hemoblastosis in combination with CKD, the vast majority were patients with the secretion of Gκ and Gλ paraproteins, free light chains (FLC). In a significant number of patients, Bens-Jones protein (BJ) in urine was determined. Less commonly, the secretion of paraproteins Dλ, Aλ, Aκ and Mκ was determined. The highest level of pathological proteins of all classes and their structural components and fragments was observed in patients with stage III CKD. A negative correlation of glomerular filtration rate (GFR) with FLCκ in the blood (r = –0.21), GFR with BJκ (r = –0.35), GFR with FLCλ in the blood (r = –0.13), GFR c BJλ, which indicates a tendency to damage the kidneys of FLC and protein BJ. Conclusion. In patients with lymphoproliferative diseases accompanied by monoclonal secretion of paraprotein and kidney damage with the development of CKD, in most cases the blood paraproteins Gκ, Gλ, FLCκ and FLCλ as well as protein BJ in urine, were determined. Paraproteins Aκ, Aλ, Mκ, Mλ, Dλ were determined much less frequently in serum. The highest level of pathological Ig and their structural components was observed in patients with stage III CKD. No association with quantitative level, type of paraprotein, and kidney damage was found. The role of FLC and BJ protein in the development of nephropathy has been confirmed.

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Glomerular filtration rate dynamics in patients with diffuse large B-cell lymphoma during induction immunopolychemotherapy

Nozdricheva,

Lysenko,

Guskova

et al. 2023

Onkogematologiâ

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Aim. To study the glomerular filtration rate (GFR) dynamics during induction immunopolychemotherapy (PCT) in patients with newly diagnosed diffuse large B-cell lymphoma. Materials and methods. The study included 39 patients with newly diagnosed diffuse large b-cell lymphoma who received specialized treatment in oncohematology department of national medical research centre for oncology (Rostov-on-Don). Patients underwent induction pct according to the R-CHOP (rituximab, doxorubicin, cyclophosphamide, vincristine, prednisolone) regimen with accompanying therapy (allopurinol). blood sampling was carried out at 0, 24, 48, 72, 120 hours and 21 days of the 1st PCT cycle. GFR was calculated using the SKD-epicre formula (chronic Kidney disease epidemiology collaboration creatinine-based). statistical data processing was carried out using the IBM SPSS statistics 23 program. Results. According to the gfr level before the start of chemotherapy (0 hours), the patients were divided into two groups: group a with GFR > 90 ml / min / 1.73 m2 and group b with GFR < 90 ml / min / 1.73 m2. In group a, there were no significant dynamic changes in the GFR level during PCT. Group B patients reacted more acutely to the administration of pct, which was manifested in an even greater decrease in the gfr level at 48 hours of PCT, and at 120 hours of PCT, the GFR approached the optimal values. on the 21st day from the start of the 1st pct course, the studied indicator returned to its initial values at 0 hour. further, the patients of these groups were divided into subgroups depending on the disease stage: group a consisted of 12 people with stages I–II and 15 people with stages III–IV. In group B, there were an equal number of patients with stages I–II and III–IV – 6 people. In group a, in patients with stages I–II and III–IV before the start of PCT (0 hours) and during PCT, there were no differences in the GFR level dynamics. In group B, patients with stages I-II and III–IV had similar GFR before the start of PCT, and during treatment, they reflected the previously noted general group trend in GFR level dynamics. Conclusion. The study found that in patients with initially low GFR level, a further, even more pronounced decrease in GFR during pct is observed. at the same time, the absence of significant differences in GFR level depending on disease stage allows us to conclude that the leading role is not so much the stage of the disease and tumor volume, but rather the initial functional status of the kidneys in the development of renal dysfunction in patients with diffuse large B-cell lymphoma during R-CHOP therapy.

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Clinical, laboratory, and morphological characteristics of kidney damage in lymphoproliferative disorders

Cited by 5 publications

References 15 publications

The role of paraproteins in kidney damage in patients with lymphoproliferative diseases

The role of paraproteins in kidney damage in patients with lymphoproliferative diseases

The correlation between the level of secretion and the type of monoclonal paraprotein and kidney damage in lymphoproliferative disorders

Glomerular filtration rate dynamics in patients with diffuse large B-cell lymphoma during induction immunopolychemotherapy

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