Membranous Glomerulonephritis with Nephrotic Syndrome Associated with Chronic Lymphocytic Leukemia

Yahata, Naoyuki; Kawanishi, Yasuo; Okabe, Seiichi; Kimura, Yukihiko; Okada, Tomonari; Otani, Masako; Shimizu, Tohru; Nakao, Toshiyuki; Ohyashiki, Kazuma

doi:10.1159/000013626

Cited by 21 publications

(15 citation statements)

References 8 publications

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“…Furthermore, 4/8 MGN cases had lymphocytic infiltration, which was restricted to the interstitial region and not directly associated with the occurrence of nephrotic syndrome [4]. In the present case, the infiltrative lymphocytes were morphologically and phenotypically the same as CLL cell.…”

Section: Case Reportsupporting

confidence: 43%

“…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]. We now present another case and review the previously reported from the viewpoint of histological and immunological data.…”

Section: Introductionmentioning

confidence: 88%

“…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.…”

Section: Case Reportmentioning

confidence: 99%

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Membranous glomerulonephritis in chronic lymphocytic leukemia

et al. 2004

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We present a case of chronic lymphocytic leukemia associated with nephrotic syndrome. Renal biopsy revealed membranous glomerulonephritis accompanied by interstitial monoclonal lymphocytic infiltration. Combination therapy with cyclophosphamide, vincristine, and prednisone (COP) was successful in inducing an effective response in chronic lymphocytic leukemia. Improvement of renal function and proteinuria was also observed. Am.

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Section: Case Reportsupporting

confidence: 43%

Section: Introductionmentioning

confidence: 88%

Section: Case Reportmentioning

confidence: 99%

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Membranous glomerulonephritis in chronic lymphocytic leukemia

et al. 2004

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“…Most of these CLL-associated cases are single patient case reports or small case series, with the largest report to date including 15 patients. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Here we report the pathological findings and outcomes of a series of 49 patients with CLL and MBL followed at a single institution, who underwent a kidney biopsy during the course of their disease to evaluate renal insufficiency and/or nephrotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience

et al. 2015

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© F e r r a t a S t o r t i F o u n d a t i o ntent interstitial lymphocytic infiltration was observed. Standard processing of kidney biopsies evaluated at the Mayo Clinic included light microscopy, immunofluorescence, and electron microscopy. For light microscopy, biopsy specimens were stained with hematoxylin-eosin, periodic acid Schiff, Masson trichrome, and Jones methenamine silver. For immunofluorescence, 3-micron cryostat sections were stained with polyclonal fluorescein isothiocyanate-conjugated antibodies to IgG, IgM, IgA, C3, C1q, kappa and lambda light chains, fibrinogen, and albumin (Dako), as per routine clinical testing. Electron microscopy was performed as per clinical routine.Immunohistochemical stains for CD3, CD5, CD20, and CD23 were done in cases of interstitial lymphocytic infiltration (and for PAX5 and CD19 in selected cases) to help assess CLL/SLL involvement. Renal biopsy findings were further classified according to a potential causal relationship with CLL. Cases of membranoproliferative glomerulonephritis (MPGN), CLL infiltrate as primary etiology, minimal change disease (MCD), acute interstitial nephritis, amyloidosis, light chain cast nephropathy, membranous glomerulonephritis, and unclassified mesangial proliferative glomerulonephritis were considered directly related to CLL. Cases secondary to CLL-associated conditions, such as infections, autoimmune disease, and other cancers, or CLL treatment were considered potentially indirectly related to CLL. Cases secondary to non-CLL associated comorbidities or non-CLL treatment, such as diabetes, hypertension or obesity, were considered unrelated to CLL. Statistical analysisDescriptive statistics of baseline characteristics were calculated. The Mann-Whitney test was used for comparisons of medians. Overall survival was defined as time from diagnosis to death or last follow up. Survival curves were calculated using the Kaplan-Meier method, and comparisons were made using the log-rank test. All P-values were two-sided and considered statistically significant if ≤0.05. Statistical analyses were completed using SPSS 21. Results Baseline characteristicsBetween January 1 st , 1995 and June 30 th , 2014, 4,024 patients with CLL, SLL or MBL were followed at our institution. Of these patients, 49 (1.2%) had an ultrasound-guided kidney biopsy during follow-up to evaluate renal failure and/or nephrotic syndrome. Of these biopsies, 10% were performed before 2005, 49% between 2005 and 2010, and 41% after 2010. The indication for renal biopsy was renal insufficiency (without evidence of post-renal compression or tumor lysis) in 34 patients (69%; median creatinine 3.2 mg/dL, range 1.7-15) and nephrotic syndrome in 15 (31%; median proteinuria 11.3 g/24 hours, range 4-54.9). The pertinent baseline characteristics of these 49 patients at the time of CLL diagnosis are shown in Table 1.Kidney biopsy results are shown in Table 2. The distribution of renal pathology based on the indication for biopsy is shown in Figure 1. Of interest, among the five patie...

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“…qPCR performed on plasma samples showed steadily increasing levels of BK virus DNA over time, which coincided with decreasing renal function. We excluded a number of explanations other than BKVN as the cause of his nephropathy, including CLL invasion in the kidneys, CLL-associated glomerular lesions such as membranous or membrano-proliferative glomerulopathy, 11 GvH disease, and relevant viral infections.…”

Section: Discussionmentioning

confidence: 99%