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

Kamat, Anil Vaikunth; Goldsmith, David; O’Donnell, Patrick; Walt, Jon van der; Carr, Robert

doi:10.1080/08860220701460459

Cited by 18 publications

(16 citation statements)

References 11 publications

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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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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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“…Both patients presented with severe renal impairment requiring renal replacement therapy. Kidney biopsy in all 5 patients reported here and the 2 patients reported previously showed leukemic interstitial infiltration concomitant with GIN [23,24]. Granulomatous interstitial nephritis is likely a bigger contributor to renal failure than CLL/SLL infiltration because it was generally more extensive and was accompanied by tubulitis.…”

Section: Discussionmentioning

confidence: 63%

“…However, the 2 patients had been on these medications for many years without side effects; therefore, it is unlikely that they were responsible for GIN. Two additional patients with CLL/SLL causing GIN have been reported previously [23,24]. Chronic lymphocytic leukemia/SLL was diagnosed concomitantly with GIN in 1 and 1.5 years prior in the other patient.…”

Section: Discussionmentioning

confidence: 88%

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

Nasr

Shanafelt

Hanson

et al. 2015

Annals of Diagnostic Pathology

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“…First, sarcoidosis‐related fever was difficult diagnose on account of the malignancy. By means of searching PubMed, we found reports of 25 cases of sarcoidosis in hemodialysis patients since 2000 (summarized in Table ) . Of the 25 cases, four presented fever and one was complicated with tumor.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary sarcoidosis as a cause of intermittent fever of unknown origin in a hemodialysis patient with renal cell carcinoma: A case report and literature review

Shima¹,

Nishitani²,

Tashiro³

et al. 2019

Hemodialysis International

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Hemodialysis patients have weakened immune systems and can exhibit fever due to various causes. Herein, we describe the case of a 61‐year‐old hemodialysis patient who exhibited intermittent low‐grade fever after a pacemaker had been implanted 2 months before due to sick sinus syndrome. She had a medical history of subcutaneous sarcoidosis and uveitis. Active pulmonary sarcoidosis was diagnosed based on elevated soluble interleukin‐2 receptor, elevated lysozyme level, and gallium‐67 scintigraphy uptake in hilar and mediastinal lymph nodes. She was also diagnosed with renal cell carcinoma via contrast computed tomography. However, because her C‐reactive protein level remained normal, the possibility of neoplastic fever was considered low. After the initiation of prednisolone administration, her fever gradually disappeared. Her serum soluble interleukin‐2 receptor and lysozyme level improved in parallel with the enlargement of the mediastinal lymph node and gallium‐67 scintigraphy uptake.

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

Cited by 18 publications

References 11 publications

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

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

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

Pulmonary sarcoidosis as a cause of intermittent fever of unknown origin in a hemodialysis patient with renal cell carcinoma: A case report and literature review

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