Concurrent nephrotic syndrome and acute renal failure caused by chronic lymphocytic leukemia (CLL): a case report and literature review

Abstract

Kidney injury associated with lymphocytic leukemia (CLL) is typically caused by direct tumor infiltration which occasionally results in acute renal failure. Glomerular involvement presenting as proteinuria or even nephrotic syndrome is exceptionally rare. Here we report a case of 54-year-old male CLL patient with nephrotic syndrome and renal failure. The lymph node biopsy confirmed that the patients had CLL with remarkable immunoglobulin light chain amyloid deposition. The renal biopsy demonstrated the concurrence of AL amyloidosis and neoplastic infiltration. Combined treatment of fludarabine, cyclophosphamide and rituximab resulted in remission of CLL, as well as the renal disfunction and nephrotic syndrome, without recurrence during a 12-month follow-up. To our knowledge, this is the first case of CLL patient showing the nephrotic syndrome and acute renal failure caused by AL amyloidosis and neoplastic infiltration. Though AL amyloidosis caused by plasma cell dyscrasia usually responses poorly to chemotherapy, this patient exhibited a satisfactory clinical outcome due to successful inhibition of the production of amylodogenic light chains by combined chemotherapy.

Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience

“…Most of these CLL-associated cases are single patient case reports or small case series, with the largest report to date including 15 patients. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Here we report the pathological findings and outcomes of a series of 49 patients with CLL and MBL followed at a single institution, who underwent a kidney biopsy during the course of their disease to evaluate renal insufficiency and/or nephrotic syndrome.…”

Ultrasound-guided percutaneous renal biopsy-induced accessory renal artery bleeding in an amyloidosis patient

“…Primary systemic (AL) amyloidosis is a clonal plasma cell disorder in which the N-terminal fragments of monoclonal light chains form fibrils that accumulate in various organs ultimately leading to organ dysfunction and death [2]. This disease is difficult to recognize and differentiate from other renal diseases [3-5] with poor prognosis because of its broad range of manifestations and vague symptoms. The accessory renal artery is a kind of renal vascular variation, which has been seen in 28-30% of normal subjects.…”

Idelalisib plus rituximab is effective in systemic AL amyloidosis secondary to chronic lymphocytic leukaemia

“…AL amyloidosis is associated with an underlying clonal plasma cell dyscrasia or with light‐chain producing B‐cell lymphoproliferative disorders, particularly lymphoplasmocytic lymphomas. Amyloidosis in chronic lymphocytic leukaemia (CLL) has rarely been described …”

“…Amyloidosis in chroniclymphocytic leukaemia (CLL) has rarely been described. [1][2][3] We report on a patient with CLL who developed systemic AL amyloidosis that was treated with the phosphoinositide 3-kinase (PI3K) inhibitor, idelalisib, plus rituximab.A 61-year-old man was followed at our Haematology Unit since June 2004 for CLL. At diagnosis, he had lymphocytosis (22.000/μL), thrombocytopenia (platelets 4.000/μL), and an IgM/K monoclonal component (M-protein) of 2 g/L.…”

“…lymphocytic leukaemia (CLL) has rarely been described. [1][2][3] We report on a patient with CLL who developed systemic AL amyloidosis that was treated with the phosphoinositide 3-kinase (PI3K) inhibitor, idelalisib, plus rituximab.…”