Kidney involvement and renal manifestations in non‐Hodgkin's lymphoma and lymphocytic leukemia: a retrospective study in 700 patients

Abstract

Renal involvement as part of systemic lymphoma (LY) is quite frequent, however, primary extranodal renal non-Hodgkin's lymphoma (NHL) is extremely rare, and only about 65 cases have been reported in the world literature. In a retrospective study of renal manifestations in 700 patients with documented LY and chronic lymphocytic leukemia (CLL) seen at our hospital during 1986-95, 83 patients had signs of acute renal failure. Only five of these had proven renal infiltration, but none of them satisfied the criteria for primary renal LY. Glomerulonephritis (GN) has also rarely been reported in association with LY and CLL, and only 37 glomerular lesions in NHL and 42 in CLL have been documented, respectively. GN may precede, coexist, or follow the diagnosis of LY by several years. Of the 42 cases of CLL reported worldwide, 36 had nephrotic syndrome. Renal failure was seen in about one third. The most common glomerular lesion reported is membranoproliferative GN, followed by membranous GN. In our study, we found only five biopsy-proven cases with GN amongst the 700 patients seen. In this report we also briefly describe some rare interesting associated renal syndromes in CLL and NHL.

Diffuse large B-cell lymphoma with involvement of the kidney: outcome and risk of central nervous system relapse

“…[3][4][5][6][7][8] There are limited data describing the clinical course and outcomes of patients with DLBCL and renal involvement and many prior studies were based on older lymphoma classification systems. [9][10][11][12] Retrospective cohort studies reveal that these patients tend to present with widespread disease and have a poor outcome in part due to a high rate of central nervous system (CNS) relapse.…”

Membranous glomerulonephritis in chronic lymphocytic leukemia

“…Although circulating immune complexes associated with cryoglobulins play a significant role in the pathogenesis of MPGN in CLL, in all CLL-associated MGN cases, monoclonal proteins (and cryoglobulins) are absent. However, it seems that MGN in CLL is associated with immunoglobulin and complement deposition on the glomerular basement membrane, even in the absence of monoclonal component and complement consumption [2][3][4][5]. The presence of these immune deposits that contain IgG and C3 is suggestive of an immune process.…”

“…Although up to 90% of CLL cases display kidney infiltration at autopsy, renal involvement generally remains clinically undetected. Obstruction of the ureters, sepsis, hemolysis, and therapy-related toxicity are the most common causes of renal disease in these patients [2]. Furthermore, nephrotic syndrome in CLL is a rare complication occurring in less than 2% of the cases [3].…”

“…The most common type (35.7%) proved to be Type I and II membranoproliferative glomerulonephritis (MPGN), followed by membranous glomerulonephritis (MGN) (19%); less frequent causes included minimal-change disease, focal segmental glomerulosclerosis, focal or diffuse proliferative glomerulopathy, amyloidosis, and immunotactoid glomerulonephritis. The pathophysiology of glomerulonephritis in CLL is considered to be related to the glomerular deposition of the monoclonal component secreted by the B-cell clone or to the formation of immune complexes [2,3]. Eight MGN cases with nephrotic syndrome in CLL have been reported to date [4].…”

Fludarabine in Chronic Lymphocytic Leukemia with Membranous Nephropathy

“…4 To date, only 12 cases of MN complicating CLL have been reported in literature. 2,[4][5][6][7][8][9][10][11][12][13] We present another case of MN during CLL treated with fludarabine.…”