Renal failure caused by leukaemic infiltration in chronic lymphocytic leukaemia.

Phillips, Julia; Bass, Paul; Majumdar, G.; Davies, David R.; Jones, N. F.; Tc, Pearson

doi:10.1136/jcp.46.12.1131

Cited by 41 publications

(17 citation statements)

References 8 publications

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“…There have been occasional reports in the literature describing renal dysfunction following leukemic infiltration with CLL. [7][8][9][10][11][12] The pathogenetic mechanisms contributing to renal dysfunction include uric acid nephropathy, light chain nephropathy, amyloidosis, hypocalcemia, urinary obstruction, glomerulonephritis and cryoglobulinemia. [11] The treatment modalities used in this setting include chemotherapy (with agents such as chlorambucil, cyclophosphamide, steroids) and renal bed irradiation.…”

Section: Discussionmentioning

confidence: 99%

Renal Failure with Granulomatous Interstitial Nephritis and Diffuse Leukemic Renal Infiltration in Chronic Lymphocytic Leukemia

et al. 2007

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Renal dysfunction is uncommon in patients with leukemic infiltration of the kidney due to Chronic Lymphocytic Leukanemia (CLL). Granulomatous interstitial nephritis (GIN) is also rare, but a characteristic hallmark of certain diseases such as sarcoidosis and tuberculosis. GIN has been associated with medications, infections, inflammation, Wegener's granulomatosis, and jejuno-ileal bypass. GIN combined with leukemic infiltration by CLL is very uncommon. We present a 72-year-old male with Binet stage A CLL who developed progressive renal failure over a period of four years requiring maintenance dialysis. During the course of his illness, he underwent renal biopsies at different time intervals, revealing varying degrees of involvement by GIN together with leukemic infiltration.

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Section: Discussionmentioning

confidence: 99%

Renal Failure with Granulomatous Interstitial Nephritis and Diffuse Leukemic Renal Infiltration in Chronic Lymphocytic Leukemia

et al. 2007

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“…Interestingly, some degree of leukemic infiltration of native kidneys is frequent in CLL patients, but the current view is that these lymphocytic infiltrates are harmless. Acute renal failure however may occur: some emblematic cases have been reported for which chlorambucil and prednisone (with or without irradiation of the kidneys) were found to be effective to some degree (6,9,10). More aggressive chemotherapy with CHOP or COP (cyclophosphamide, doxorubicin, vincristine, prednisone) has also been used in two cases with apparent effectiveness although no histologic assessment was provided (7,8 (24).…”

Section: Case Reportsmentioning

confidence: 99%

Chronic Lymphocytic Leukemia: A Hazardous Condition Before Kidney Transplantation

d‘Ythurbide

Coppo

Adem

et al. 2008

American Journal of Transplantation

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Long-term survival of patients with chronic lymphocytic leukemia (CLL) is over 10 years, and such patients are thus potential kidney recipients in the case of superimposed end-stage renal disease. However, the renal and patient outcome in this condition is unknown. We report the charts of four patients with CLL who were engrafted in France with a deceased-donor kidney and underwent routine triple immunosuppressive therapy. The results show that these patients developed severe infectious episodes (fatal in one case) and tumoral complications including rapid progression of CLL in two cases. Moreover, the graft may be infiltrated and damaged by monoclonal B cells: one patient lost his graft 14 months after transplantation. Various therapeutic options (modifications of the immunosuppressive regimen, anti-CD20 antibodies, irradiation of the graft) showed little (if any) efficacy. Therefore, we believe that CLL is a too hazardous condition to envisage solid organ transplantation with a routine immunosuppressive regimen, and we propose a more appropriate approach.

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“…In particular, up to 90% of patients with CLL and no previous renal abnormalities have some degree of renal interstitial infiltration on autopsy. [2][3][4][5] Although interstitial CLL infiltration of the kidney can have clinical manifestations, only ten cases of acute renal failure secondary to CLL infiltration have been reported in the literature. 2,[6][7][8][9][10][11] Collectively, 81 cases of biopsy-proven glomerular or interstitial renal abnormalities due to CLL have been reported in the literature to date, whereas no cases associated with monoclonal B-cell lymphocytosis (MBL) have been described.…”

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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Renal failure caused by leukaemic infiltration in chronic lymphocytic leukaemia.

Cited by 41 publications

References 8 publications

Renal Failure with Granulomatous Interstitial Nephritis and Diffuse Leukemic Renal Infiltration in Chronic Lymphocytic Leukemia

Renal Failure with Granulomatous Interstitial Nephritis and Diffuse Leukemic Renal Infiltration in Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia: A Hazardous Condition Before Kidney Transplantation

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

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