Renal Failure Due to Leukaemic Infiltration in Chronic Lymphocytic Leukaemia

Saggi, Subodh J.; Calandri, Cesare; Muhlfelder, Thomas W.; Choi, Hongyung; Kahn, Thomas; Kaji, Deepak

doi:10.1093/ndt/5.12.1051

Cited by 19 publications

(11 citation statements)

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“…[10] Several case reports have described patients with only mild CLL disease activity (as in our patient) although more aggressive forms can also exist along with renal failure. [11–17] Despite thorough initial investigation, a straightforward cause for our patient's renal impairment was not apparent. Thus, a renal biopsy was required for diagnosis.…”

Section: Discussionmentioning

confidence: 89%

Rapidly progressive renal failure due to chronic lymphocytic leukemia - Response to chlorambucil

2012

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Chronic lymphocytic leukemia tends to follow an indolent course and despite infiltration of leukemic cells in numerous organs, resultant target organ damage is uncommon. We present a case of an 83-year-old Caucasian lady who presented with rapidly worsening renal impairment over a several month period with a serum creatinine peak of 2.82 mg/dl. Despite numerous investigations an immediate cause was not apparent. A renal biopsy was therefore conducted which revealed dense infiltration of the interstitium with small lymphocytic lymphoma. Given her age and frailty she was treated with single alkylating agent chemotherapy (chlorambucil). This resulted in a marked decrease in lymphocyte count and resolution of renal impairment close to her previous baseline level. To our knowledge, this is the first case in the literature to demonstrate a marked resolution in renal impairment with chlorambucil alone. We also highlight the value of renal biopsy in identifying a rare cause of renal impairment.

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Section: Discussionmentioning

confidence: 89%

Rapidly progressive renal failure due to chronic lymphocytic leukemia - Response to chlorambucil

2012

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“…Interestingly, some degree of leukemic infiltration of native kidneys is frequent in CLL patients, but the current view is that these lymphocytic infiltrates are harmless. Acute renal failure however may occur: some emblematic cases have been reported for which chlorambucil and prednisone (with or without irradiation of the kidneys) were found to be effective to some degree (6,9,10). More aggressive chemotherapy with CHOP or COP (cyclophosphamide, doxorubicin, vincristine, prednisone) has also been used in two cases with apparent effectiveness although no histologic assessment was provided (7,8 (24).…”

Section: Case Reportsmentioning

confidence: 99%

Chronic Lymphocytic Leukemia: A Hazardous Condition Before Kidney Transplantation

d‘Ythurbide

Coppo

Adem

et al. 2008

American Journal of Transplantation

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Long-term survival of patients with chronic lymphocytic leukemia (CLL) is over 10 years, and such patients are thus potential kidney recipients in the case of superimposed end-stage renal disease. However, the renal and patient outcome in this condition is unknown. We report the charts of four patients with CLL who were engrafted in France with a deceased-donor kidney and underwent routine triple immunosuppressive therapy. The results show that these patients developed severe infectious episodes (fatal in one case) and tumoral complications including rapid progression of CLL in two cases. Moreover, the graft may be infiltrated and damaged by monoclonal B cells: one patient lost his graft 14 months after transplantation. Various therapeutic options (modifications of the immunosuppressive regimen, anti-CD20 antibodies, irradiation of the graft) showed little (if any) efficacy. Therefore, we believe that CLL is a too hazardous condition to envisage solid organ transplantation with a routine immunosuppressive regimen, and we propose a more appropriate approach.

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“…However, chronic renal failure seems to respond better to combination chemotherapy with cyclophosphamide, vincristine and prednisolone [9]. In addition, there are reports of renal radiotherapy together with oral prednisolone and chlorambucil as effective in some cases [10]. In our patient, initial treatment with chlorambucil resulted in an improvement in the peripheral Fig.…”

Section: Discussionmentioning

confidence: 58%

“…The response to treatment is variable, from complete response [3] to a partial or no response [10]. Chlorambucil has been reported as effective therapy in ARF due to leukaemic infiltrate in CLL [11].…”

Section: Discussionmentioning

confidence: 99%

Acute renal failure as the presenting feature of leukaemic infiltration in chronic lymphocytic leukaemia

et al. 2009

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Chronic lymphocytic leukaemia (CLL) is a neoplastic condition of B cells which commonly affects the lymph nodes, liver, spleen and bone marrow. Leukaemic involvement of the kidney is also relatively common in CLL, but characteristically is not associated with renal impairment. Our report describes a patient who developed acute renal failure as the initial presenting feature of CLL. The renal failure was subsequently found to be due to direct leukaemic infiltration. Treatment with chlorambucil and prednisolone resulted in stabilisation of the renal function for approximately 1 year prior to the need for long-term haemodialysis. Leukaemic infiltration of kidney should always be considered when a patient with CLL presents with renal impairment, regardless of the clinical stage, as the renal failure often responds well to chemotherapy.

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Renal Failure Due to Leukaemic Infiltration in Chronic Lymphocytic Leukaemia

Cited by 19 publications

References 0 publications

Rapidly progressive renal failure due to chronic lymphocytic leukemia - Response to chlorambucil

Rapidly progressive renal failure due to chronic lymphocytic leukemia - Response to chlorambucil

Chronic Lymphocytic Leukemia: A Hazardous Condition Before Kidney Transplantation

Acute renal failure as the presenting feature of leukaemic infiltration in chronic lymphocytic leukaemia

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