Minimal Change Nephrotic Syndrome Associated With Non-Hodgkin Lymphoid Disorders

Abstract

Few studies have examined the occurrence of minimal change nephrotic syndrome (MCNS) in patients with non-Hodgkin lymphoma (NHL). We report here a series of 18 patients with MCNS occurring among 13,992 new cases of NHL. We analyzed the clinical and pathologic characteristics of this association, along with the response of patients to treatment, to determine if this association relies on a particular disorder. The most frequent NHLs associated with MCNS were Waldenström macroglobulinemia (33.3%), marginal zone B-cell lymphoma (27.8%), and chronic lymphocytic leukemia (22.2%). Other lymphoproliferative disorders included multiple myeloma, mantle cell lymphoma, and peripheral T-cell lymphoma. In 4 patients MCNS occurred before NHL (mean delay, 15 mo), in 10 patients the disorders occurred simultaneously, and in 4 patients MCNS was diagnosed after NHL (mean delay, 25 mo). Circulating monoclonal immunoglobulins were present in 11 patients. A nontumoral interstitial infiltrate was present in renal biopsy specimens from 3 patients without significant renal impairment. Acute kidney injury resulting from tubular lesions or renal hypoperfusion was present in 6 patients. MCNS relapse occurred more frequently in patients treated exclusively by steroid therapy (77.8%) than in those receiving steroids associated with chemotherapy (25%). In conclusion, MCNS occurs preferentially in NHL originating from B cells and requires an aggressive therapeutic approach to reduce the risk of MCNS relapse.

Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

“…Other renal pathologies, such as TMA, membranous glomerulopathy and MCD have a less clear relationship with the WM tumor clone. However, these have all been described in the context of various types of lymphoproliferative conditions including WM, MM, chronic lymphocytic leukaemia (CLL), Hodgkin and non-Hodgkin lymphoma (Da'as et al, 2001;Kofman et al, 2014;Leeaphorn et al, 2014;Lodhi et al, 2015;Strati et al, 2015). Given that these patients had no other concomitant risk factor for the renal condition besides WM, and the was a temporal relationship between the WM and renal diagnosis, we consider it likely that the renal pathology was related to WM.…”

Minimal Change Disease as Initial Presentation of ALK-Positive Anaplastic Large-Cell Lymphoma in a Pediatric Patient

“…Only 4 out of 37 NHL cases from the world literature at that time presented with MCD. Kofman et al [ 7 ] reported 19 adult patients with biopsy-proven MCD from 201 patients with NHL. NS preceded, occurred simultaneously with, or followed the diagnosis of NHL.…”

Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature

“…However, when MCD is secondary to a paraneoplastic syndrome, treatment of neoplasia must also be considered. In fact, Kofman et al 21 showed that in patients with MCD in the context of non-Hodgkin lymphoma, relapse of MCD were more frequently present in patients treated only with steroids (77.8%) compared with those receiving steroids and chemotherapy (25%).…”