Membranous glomerulonephritis in chronic lymphocytic leukemia

Ziakas, Panayiotis D.; Giannouli, Stavroula; Psimenou, Erasmia; Nakopoulou, Lydia; Voulgarelis, Michalis

doi:10.1002/ajh.20109

Cited by 14 publications

(11 citation statements)

References 10 publications

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“…Early administration of penicillin is reported to prevent or ameliorate the severity of acute glomerulonephritis and at least one report suggests that APSGN patients that receive antibiotic treatment have a milder clinical course. 27,28 If infection is not apparent at the time of diagnosis, antibiotic treatment should be given anyway because positive cultures are sometimes obtained in apparently healthy patients and cross infection of household members and siblings of index cases is very high. 12 Although a 10-day course of oral antibiotic therapy with penicillin is recommended to limit the spread of the nephritogenic organisms, antibiotic therapy does not affect the natural history of glomerulonephritis.…”

Section: Indication Of Renal Biopsymentioning

confidence: 99%

Acute Post-Streptococcal Glomerulonephritis in Children A Review

Roy

Laila

2014

Bangladesh J Child Health

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Acute post-streptococcal glomerulonephritis (APSGN) is characterized by abrupt onset of hematuria, edema, hypertension, oliguria and impaired renal function following streptococcal group A â hemolytic streptococcal throat and skin infection. There is a declining incidence of APSGN worldwide, particularly in industrialized nations because of easier and earlier access to competent medical treatment of streptococcal infections and the widespread use of fluorination of water since virulence factors in streptococcus pyogens are reduced with fluoride exposure. But in the underdeveloped world, global burden of APSGN continues to be significant with lower estimate of 9.3 to 9.8 cases per 1,00,000 population per year to higher estimates as high as three times these values. Furthermore, clusters of cases are more frequently reported in poor communities in industrialized countries while epidemics of more than 100 cases are reported in the middle ranger countries with mean annual health expenditure per capita of about 550 US dollars. APSGN typically follows 1to2 weeks after pharyngeal infection and 2 to 4 weeks after skin infection by nephritogenic strains of group A â hemolytic streptococcus in a range of 5 15 years of age. Subclinical cases are 4 10 times higher than symptomatic patients. The acute phase generally resolves within 4-8 weeks but microscopic hematuria may persist for 1-2 yr after the initial presentation. Acute complications of symptomatic patients are hypertensive heart failure, encephalopathy and retinopathy. There can be acute renal failure and rarely rapidly progressive ( crescentic) glomerulonephritis, hyperkalemia, hyperphosphatemia, hypocalcemia and acidosis. Treatment is directed towards reduction of hypertension, but prompt address of complications are essential to avoid immediate mortality. Heart failure is treated with diuretic and anti-hypertensive, digoxin is ineffective. Hypertensive encephalopathy is treated by I.V phenobarbitone for convulsion, supportive measures for unconsciousness and blood pressure control. Acute renal failure is managed by supportive measures, rarely requires dialysis. Short and long term prognosis is excellent, with1% mortality during acute stage and 1% ending up with chronic kidney disease, but in higher age group abnormal urinalysis are present in higher number of patients. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20025 Bangladesh J Child Health 2014; VOL 38 (1) : 32-39

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Section: Indication Of Renal Biopsymentioning

confidence: 99%

Acute Post-Streptococcal Glomerulonephritis in Children A Review

Roy

Laila

2014

Bangladesh J Child Health

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“…Obstruction of the ureters, sepsis, hemolysis, and therapy-related toxicity are the most common causes of renal disease in patients with these diseases. 4 Glomerulonephritis with NS rarely occurs in patients with CLL and a variety of glomerular lesions have been observed. While the majority of patients with CLL-associated NS have been found to have MPGN, MN, a common cause of NS in adults and the most common glomerulonephritis in carcinomas, is rarely associated with CLL, despite the relative frequency of both diseases.…”

Section: Discussionmentioning

confidence: 99%

“…The production of autoantibodies that recognize renal epithelial cell structure as well as altered glomerular permeability caused by cytokines produced by T-cells are postulated to participate in the genesis of MN. 4 Interstitial lymphocytic infiltration occurs in 50-60% of patients with CLL. Recognition of neoplastic nature of small infiltrates may be at times challenging.…”

Section: Discussionmentioning

confidence: 99%

“…The most common type (35.7%) of glomerulonephritis causing NS during CLL is Type I and II membranoproliferative glomerulonephritis (MPGN), while less frequent causes include membranous nephropathy (MN), minimal-change disease, focal segmental glomerulosclerosis, focal or diffuse proliferative glomerulopathy, amyloidosis, and immunotactoid glomerulonephritis. 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.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Fludarabine in Chronic Lymphocytic Leukemia with Membranous Nephropathy

et al. 2012

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Chronic lymphocytic leukemia (CLL) is the most frequent form of leukemia in Western countries. Despite its relative frequency, the association of glomerular disease is extremely rare. We present a case of membranous nephropathy (MN) during CLL treated with fludarabine. A 74-year-old man was admitted to our hospital because of the onset of nephrotic syndrome (proteinuria was 7 g/24 h). Six years before, he had been diagnosed with CLL. Biochemical analysis showed the following results: creatinine was 1.7 mg/dL (creatinine clearance was 39 mL/min), urea was 64 mg/dL, hemoglobin was 8.6 g/dL, and white blood cells was 16,580/mm 3 (60% lymphocytes). The urine sediment revealed 7-8 red blood cells and many hyaline and granular casts. No monoclonal peak was demonstrated in either serum or urine electrophoresis. BenceJones proteinuria was negative. The patient underwent renal biopsy that showed MN with an extensive lymphocyte perivascular infiltration; immunohistochemistry on renal biopsy specimen showed that infiltrating lymphocytes were CD20þ. Moreover, DNA from tissue fractions was analyzed by qualitative polymerase chain reaction-based detection of clonal gene rearrangements of the immunoglobulin heavy chain gene, confirming the monoclonality of the infiltrating lymphocytes. The patient was started on fludarabine as monotherapy, with complete remission of proteinuria and recovery of renal function (creatinine clearance was 75 mL/min) after 1 year of follow-up.

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