Glomerular Injury in Chronic Myelomonocytic Leukemia

Abstract

Among 825 cases of de novo myelodysplastic syndromes (MDS) diagnosed over a period of 13 years in our center, 4 had clinically significant glomerulopathy. All 4 fulfilled diagnostic criteria of chronic myelomonocytic leukemia (CMML), and could be classified in the low or intermediate risk groups according to two scoring systems. Presenting symptoms of renal involvement were edema in 3 cases and acute renal failure in the remaining patient. Three patients had the nephrotic syndrome. Renal biopsy (performed in 2 cases but considered as contraindicated in the other cases) showed AL amyloidosis on one case and extracapillary glomerulonephritis in the other case. The 4 patients were treated with V16 or hydroxyurea and two had renal improvement. Only one previous case of MDS associated with glomerulopathy has been reported before and also very probably had CMML. This, and the response of renal disease to chemotherapy in 2 of our patients suggests a possible relationship between the two disorders. More systematic investigation of glomerular function, in CMML, could possibly disclose a higher incidence of cases of glomerular injury in this type of MDS.

A Case of Chronic Myeloid Leukemia Complicated with Minimal Change Nephrotic Syndrome

“…The most common form of nephrotic syndrome, especially in younger individuals, is minimal change nephrotic syndrome, also known as nil disease or lipoid nephrosis. In this condition, the patients have normal or nearly normal renal biopsies [1, 5]. In our case also, the renal biopsy was compatible with minimal change nephrotic syndrome.…”

“…Less commonly, nephrotic syndrome has been reported in association with non-Hodgkin’s lymphoma and CLL, the pathogenesis being either membranoproliferative glomerulonephritis or amyloidoisis [3]. The association between nephrotic syndrome and myeloid leukemias is very rare although there are some reports available on myelodysplastic syndrome, acute myeloid leukemia or chronic myelomonocytic leukemia [4, 5]…”

“…The occurrence of nephrotic syndrome has been reported in some hematopoietic malignancies, especially lymphoproliferative disorders like Hodgkin’s lymphoma and chronic lymphocytic leukemia (CLL) [2, 3, 4, 5]. In chronic myeloid leukemia (CML), nephrotic syndrome has been reported mainly as a complication associated with the administration of interferon-α therapy [6, 7, 8, 9, 10].…”

A Forgotten Cause of Kidney Injury in Chronic Myelomonocytic Leukemia

“…CMML, a hybrid disorder characterized by overlap of myelodysplastic and myeloproliferative disorders,3 affects predominantly elderly patients 4. The disorder affects kidneys through infiltration of monocytes in glomeruli,1,5 amyloid deposition, 6 production of tumor necrosis factor α,7 and, rarely, increased production and excretion of lysozyme. The case presented here is an example of the latter entity, in which overproduction of lysozyme, an enzyme stored in myelomonocytic cells, is released into the circulation, filtered by glomeruli, and taken up by tubular cells.…”

Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis

“…Only one case of membranous nephropathy and one of membranoproliferative glomerulonephritis have been reported in association with CMML; possibly because kidney biopsy is frequently contraindicated in these patients 77. Monocytes may be involved in pathogenesis of paraneoplastic glomerulonephritis since monocyte counts are higher in patients with nephrotic range proteinuria than in those without 71…”