Renal extramedullary hematopoiesis: interstitial and glomerular pathology

Alexander, Mariam P.; Nasr, Samih H.; Kurtin, Paul J.; Casey, Edward T.; Hernandez, Loren P. Herrera; Fidler, Mary E.; Sethi, Sanjeev; Cornell, Lynn D.

doi:10.1038/modpathol.2015.117

Cited by 42 publications

(15 citation statements)

References 31 publications

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“…Kidney failure and proteinuria have been reported previously in MPN patients [7][8][9]14 (Table 1). Our cohort represents a systematic, and so far the largest, collection of patients with a history of MPNs or MDS/ MPNs in whom a renal biopsy was performed.…”

Section: Discussionmentioning

confidence: 66%

Renal disease associated with myeloproliferative neoplasms and myelodysplastic syndrome/myeloproliferative neoplasms

et al. 2020

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Renal disease associated with myeloproliferative neoplasms and myelodysplastic syndrome/myeloproliferative neoplasms Aims: Renal changes in patients with myeloproliferative neoplasms (MPNs) or myelodysplastic syndrome (MDS)/MPNs have been addressed by few, respectively no, reports. The aim of this study was to focus on a systematic evaluation of renal biopsies in patients with MPNs or MDS/MPNs. Methods and results: The cohort comprised 29 patients (23 men) aged 67 AE 11 years (mean AE standard deviation), diagnosed with chronic myeloid leukaemia (n = 5), polycythaemia vera (n = 9), primary myelofibrosis (n = 5), essential thrombocythaemia (n = 2), or chronic myelomonocytic leukaemia (n = 4), as well as MPNs or MDS/MPNs not otherwise specified (n = 4). Patients manifested with proteinuria (93%), partially in the nephrotic range (46%), haematuria (72%), and impaired kidney function (93%). The most prominent histological findings included double-contoured glomerular basement membranes (71%), acute endothelial damage (68%), intracapillary platelet aggregation (62%), mesangiolysis (21%), thrombotic microangiopathy (24%), segmental glomerulosclerosis (66%), mesangial hypercellularity and sclerosis, extramedullary haematopoiesis (17%), and also IgA nephropathy (21%) and glomerulonephritis (GN) with features of infection-related GN (21%). MPN and MDS/MPN patients showed significantly more chronic changes than age-matched and sex-matched controls, including global and segmental glomerulosclerosis, mesangial sclerosis, and hypercellularity, whereas the extent of arteriosclerosis was comparable. Conclusions: MPN and MDS/MPN patients show glomerular scarring that exceeds age-related phenomena. Ongoing endothelial damage, growth factors released by platelets and deposition of immune complexes are probably the causative mechanisms. Early recognition of renal failure heralded by proteinuria and haematuria, and consequent control of risk factors for kidney failure, should be recommended for MPN and MDS/MPN patients.

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Section: Discussionmentioning

confidence: 66%

Renal disease associated with myeloproliferative neoplasms and myelodysplastic syndrome/myeloproliferative neoplasms

et al. 2020

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“…The latter can be seen in the setting of myeloproliferative neoplasms such as primary myelofibrosis resulting in renal extramedullary hematopoiesis. 11 In these cases, the infiltrate is composed of hematopoietic precursors of all lineages, including erythroid and myeloid progenitors, as well as megakaryocytes. The described case showed monotonousappearing small lymphocytes, which can be seen in a number of B-cell neoplasms, including chronic lymphocytic leukemia/small lymphocytic lymphoma, extranodal marginal zone lymphoma, mantle cell lymphoma, and follicular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration

Lloyd

Khalighi

2016

American Journal of Kidney Diseases

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“…Alexander et al reported 14 patients with renal EMH on kidney biopsy specimens from 1994 to 2015 [ 6 ]. All presented with reduced renal function, including five (36%) patients with acute renal failure.…”

Section: Discussionmentioning

confidence: 99%

A case of perirenal extramedullary hematopoiesis in a patient with primary myelofibrosis

et al. 2017

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Extramedullary hematopoiesis (EMH) is hematopoiesis in organs outside the bone marrow and most frequently occurs in the liver, spleen, and lymph nodes. We report a case of perirenal EMH revealed by kidney biopsy in a patient with primary myelofibrosis. We observed only bilateral kidney enlargement with plain computed tomography (CT) and ultrasonography before obtaining a renal biopsy. We obtained a percutaneous biopsy from the lower pole of the left kidney using ultrasonographic guidance. Ultrasonography just after the renal biopsy revealed no bleeding around the kidney. However, early the next morning, the patient developed severe hemorrhagic shock. Contrast-enhanced CT at that time revealed a massive hematoma in the left posterior perirenal space and bilateral abnormalities of the perirenal soft tissues. In patients with primary myelofibrosis, if plain CT shows an abnormal renal enlargement, EMH should be considered. In addition, a contrast-enhanced CT should be obtained before performing a percutaneous renal biopsy to assess for the possibility of perirenal EMH in these patients.

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Renal extramedullary hematopoiesis: interstitial and glomerular pathology

Cited by 42 publications

References 31 publications

Renal disease associated with myeloproliferative neoplasms and myelodysplastic syndrome/myeloproliferative neoplasms

Renal disease associated with myeloproliferative neoplasms and myelodysplastic syndrome/myeloproliferative neoplasms

Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration

A case of perirenal extramedullary hematopoiesis in a patient with primary myelofibrosis

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