Paraneoplastic immunoglobulin A nephropathy and associated focal segmental glomerulosclerosis in asymptomatic low volume B-cell lymphoma – a case report

Abstract

BackgroundParaneoplastic glomerulonephritis is rare in haematological malignancies and tends to manifest as minimal change disease, membranous glomerulonephritis or membranoproliferative glomerulonephritis. We present the first report of immunoglobulin A nephropathy and associated focal segmental glomerulosclerosis in a patient with asymptomatic low grade B-cell lymphoma.Case presentationA 53 year old gentleman presented with nephrotic range proteinuria (urine protein creatinine ratio of 662 mg/mmol) on a background of type 2 diabetes mellitus (glycosylated haemoglobin: < 6%), hypertension, obesity (body mass index: 47.6 kg/m2) and degenerative spine disease. Bone marrow biopsy diagnosed a low grade B-cell lymphoma and renal biopsy was consistent with immunoglobulin A nephropathy. Lymphoma treatment with six cycles of cyclophosphamide/ rituximab/ prednisolone led to normalisation of urinary protein excretion (urine protein creatinine ratio: 14 mg/mmol at 26 months post-chemotherapy).ConclusionParaneoplastic immunoglobulin A nephropathy can occur with a broad range of haematological malignancies regardless of stage. This case illustrates the importance of meticulous haematological system work-up for patients presenting with immunoglobulin A nephropathy. Recognition of paraneoplastic immunoglobulin A nephropathy and early diagnosis of associated malignancy can be life-saving.

IgA Nephropathy with Dominant IgA2 Deposition Accompanied by Mantle Cell Lymphoma

“…Malignant lymphoma rarely complicates IgA nephropathy, except for Hodgkin lymphoma ( 13 , 14 ), angioimmunoblastic T-cell lymphoma ( 15 ), mucosa-associated lymphoid tissue lymphoma ( 16 ), and low-grade B-cell lymphoma ( 17 ). To our knowledge, this is the first report of IgA nephropathy secondary to MCL.…”

Galactose-Deficient IgA1 Deposits in Clear Cell Renal Cell Carcinoma-Related Henoch–Schönlein Purpura Nephritis

“…e renal manifestations of HSPN can range from microscopic hematuria and proteinuria only to a rapidly progressive glomerulonephritis (RPGN). Of those who undergo a kidney biopsy, 95% show IgA deposition in the mesangial area [12][13][14][15][16][17][18][19][20][21][22]. e most frequent lesion in renal biopsies is proliferative endocapillary glomerular nephritis [11].…”

“…Case Reports in Nephrology [10-12, 14, 16, 18, 21] although significant improvement of renal function was reported in some cases with treatment of the cancer and corticosteroids for HSPN [13][14][15]22]. e independent prognostic factors of renal outcome in patients with HSPN are proteinuria level, initial renal failure, and the histologic quantification of interstitial fibrosis and glomerular sclerosis [11].…”

“…The most frequent lesion in renal biopsies is proliferative endocapillary glomerular nephritis [ 11 ]. The outcome of HSPN in adults is relatively poor, and the most frequent cause of death was neoplasia (up to 27% of death) [ 10 – 12 , 14 , 16 , 18 , 21 ] although significant improvement of renal function was reported in some cases with treatment of the cancer and corticosteroids for HSPN [ 13 – 15 , 22 ]. The independent prognostic factors of renal outcome in patients with HSPN are proteinuria level, initial renal failure, and the histologic quantification of interstitial fibrosis and glomerular sclerosis [ 11 ].…”

Optimization of the protocol for kidney gross examination after nephrectomy due to neoplasm

“…Реже встречаются доброкачественные опухоли почки, например онкоцитома и ангиомиолипома [1]. В литературе имеются данные о развитии при злокачественных новообразованиях паранеопластических гломерулопатий, а также нефропатий, связанных с нарушением метаболизма [2][3][4][5][6][7][8][9][10][11][12]. Наряду с этим у пациентов могут быть гломерулопатии и нарушения обмена веществ, не связанные с опухолью [13].…”