Minimal Change Glomerulonephritis in Chronic Lymphocytic Leukemia: Pathophysiological and Therapeutic Aspects

Abstract

Background: So far, only 9 cases of minimal change glomerulonephritis (MCGN) related to chronic lymphocytic leukemia (CLL) have been described. Case Report: Our patient presented with severe nephrotic syndrome. Diagnostic biopsies confirmed MCGN and early-stage BCLL (Binet A). In contrast to previously described cases, kappa monoclonal IgM and cryoglobulins were also detected. The patient was treated with chlorambucil and prednisone. 3 weeks later, renal function and white blood cell (WBC) count were completely normal. Discussion: Although, in most cases, renal disease and CLL present separately, there is evidence for a causal relationship between the two disorders. Although it is widely approved that early-stage CLL should not be treated by medication, the severe nephrotic syndrome in our patient required immediate intervention. So far, there is no standard therapy for MCGN associated with CLL. Our combination therapy resulted in normalization of the nephrotic syndrome and the WBC count. Hence, we emphasize the importance of early recognition of renal symptoms in CLL and propose a successful therapy for nephrotic syndrome in MCGN associated with early-stage B-CLL. Additionally, the pathophysiological and therapeutic aspects of MCGN associated with CLL are retrospectively discussed.

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

“…The immune pathogenesis of MCD in CLL is further supported by the high response rate and response duration reported both in the literature and in our study with the use of immunosuppressive agents, such as prednisone or rituximab-based regimens. 13,22,23 The combination of our series and cases reported in the literature shows that MPGN, CLL infiltration and MCD are the three most common findings in patients with CLL and renal abnormalities (Table 4). Of interest, the addition of our data to the reported literature highlighted the high prevalence of membranous glomerulonephritis.…”

“…41,42 A similar mechanism has been advocated for MCD complicating B-cell neoplasias, including CLL and other non-Hodgkin lymphomas, in which T-cell dysfunction is a common finding. 23,43,44 It should be noted that all cases of MCD in our series presented with the nephrotic syndrome. The immune pathogenesis of MCD in CLL is further supported by the high response rate and response duration reported both in the literature and in our study with the use of immunosuppressive agents, such as prednisone or rituximab-based regimens.…”

“…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.…”

Concurrent nephrotic syndrome and acute renal failure caused by chronic lymphocytic leukemia (CLL): a case report and literature review

“…Severe proteinuria or even nephrotic syndrome often suggests glomerular involvement [7,10]. Though CLL is rarely complicated with nephrotic syndrome, a spectrum of glomerular diseases including light chain deposition disease (LCDD), AL, membranoproliferative glomerulonephritis (MPGN) [11], membrane nephropathy (MN) and minimal change disease (MCD) have been reported, which suggests the presence of various pathogenesis pathways of CLL-associated nephrotic syndrome[2,7,11-13]. The glomerular injuries may be directly caused by the lymphoplasmacytic neoplasm through a paraprotein deposition process which finally results in amyloidosis or monoclonal immunoglobulin deposition disease or the indirect immune-mediated mechanisms may also be involved.…”

Chronic lymphocytic leukemia associated with immunotactoid glomerulopathy: a case report of successful treatment with high-dose methylprednisolone in combination with rituximab followed by alemtuzumab

“…It is also hypothesized that that the proliferating B-lymphocytes, arrested in their physiologic differentiation, produce abnormally organized antibody deposits within the glomerular tufts, and cause elevated levels of complement or cytokines with a resultant increase in the permeability of Bowman’s capsule. 1,10,11 . Others speculate that CLL patients may have viral infections that may contribute to both hematological malignancy and glomerulonephropathy development 5,12 .…”