1
|
Danesin N, Scapinello G, Del Prete D, Naso E, Berno T, Visentin A, Bonaldi L, Martines A, Bertorelle R, Vianello F, Gurrieri C, Zambello R, Castellani C, Fedrigo M, Rizzo S, Angelini A, Trentin L, Piazza F. When Waldenström macroglobulinemia hits the kidney: Description of a case series and management of a "rare in rare" scenario. Cancer Rep (Hoboken) 2024; 7:e2062. [PMID: 38662353 PMCID: PMC11044914 DOI: 10.1002/cnr2.2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Renal injury related to Waldenström macroglobulinemia (WM) occurs in approximately 3% of patients. Kidney biopsy is crucial to discriminate between distinct histopathological entities such as glomerular (amyloidotic and non-amyloidotic), tubulo-interstitial and non-paraprotein mediated renal damage. In this context, disease characterization, management, relationship between renal, and hematological response have been poorly explored. We collected clinical, genetic and laboratory data of seven cases of biopsy-proven renal involvement by WM managed at our academic center and focused on three cases we judged paradigmatic discussing their histopathological patterns, clinical features, and therapeutic options. CASE In this illustrative case series, we confirm that serum creatinine levels and 24 h proteinuria are parameters that when altered should prompt the clinical suspicion of WM-related renal involvement, even if at present there are not precise cut-off levels recommending the execution of a renal biopsy. In our series AL Amyloidosis (n = 3/7) and tubulo-interstitial infiltration by lymphoma cells (n = 3/7) were the two more represented entities. BTKi did not seem to improve renal function (Case 1), while bortezomib-based regimens demonstrated a beneficial activity on the hematological and organ response, even when used as second-line therapy after chemoimmunotherapy (Case 3) and also with coexistence of anti-MAG neuropathy (Case 2). In case of poor response to bortezomib, standard chemoimmunotherapy (CIT), such as rituximab-bendamustine, represents an effective option (Case 1, 6, and 7). In our series, CIT generates durable responses more frequently in cases with amyloidogenic renal damage (Case 1, 5, and 7). CONCLUSION In this illustrative case series, we confirm that serum creatinine levels and 24 h proteinuria are parameters that when altered should prompt the clinical suspicion of WM-related renal involvement, even if at present there are not precise cut-off levels recommending the execution of a renal biopsy. Studies with higher numerosity are needed to better clarify the pathological and clinical features of renal involvement during WM and to determine the potential benefit of different therapeutic regimens according to the histopathological subtypes.
Collapse
Affiliation(s)
- Nicolò Danesin
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Greta Scapinello
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Dorella Del Prete
- Nephrology, Dialysis and Transplantation Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Elena Naso
- Nephrology, Dialysis and Transplantation Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Tamara Berno
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Andrea Visentin
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Laura Bonaldi
- Immunology and Molecular Oncology Diagnostic Unit, Veneto Institute of OncologyIOV‐IRCCSPadovaItaly
| | - Annalisa Martines
- Immunology and Molecular Oncology Diagnostic Unit, Veneto Institute of OncologyIOV‐IRCCSPadovaItaly
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Diagnostic Unit, Veneto Institute of OncologyIOV‐IRCCSPadovaItaly
| | - Fabrizio Vianello
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
- Veneto Institute of Molecular MedicineFondazione per la Ricerca Biomedica AvanzataPadovaItaly
| | - Carmela Gurrieri
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Renato Zambello
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
- Veneto Institute of Molecular MedicineFondazione per la Ricerca Biomedica AvanzataPadovaItaly
| | - Chiara Castellani
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Marny Fedrigo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Livio Trentin
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Francesco Piazza
- Hematology Unit, Department of MedicineUniversity of PadovaPadovaItaly
- Veneto Institute of Molecular MedicineFondazione per la Ricerca Biomedica AvanzataPadovaItaly
| |
Collapse
|
2
|
Lee WC, Tsai CK, Li SY. Unusual Coincidence: Concurrent Cast Nephropathy and Lymphoma Infiltration in an Influenza A-Associated Acute Kidney Injury. Case Rep Nephrol 2024; 2024:5524746. [PMID: 38463384 PMCID: PMC10923615 DOI: 10.1155/2024/5524746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
Acute kidney injury (AKI) poses a substantial challenge in the management of lymphoma patients and is frequently associated with diverse causative factors. Herein, we report an illustrative case involving a 47-year-old male with influenza A infection who developed severe AKI, which was incongruent with his medical history. Laboratory investigations disclosed aberrant immunoglobulin levels and urinary protein excretion, prompting further evaluation. A renal biopsy revealed the presence of infiltrating lymphoid cells and cast nephropathy, raising suspicion of an underlying hematological disorder. A comprehensive diagnostic workup, including positron emission tomography imaging and bone marrow biopsy, culminated in the definitive diagnosis of splenic marginal zone lymphoma. This case highlights the crucial significance of including lymphoma-associated kidney disorders in the evaluation of unexplained AKI, particularly when encountering unconventional clinical and laboratory results. Swift and precise intervention is of utmost importance in attaining positive results in these rare and complex clinical situations. This study underscores the persistent concern of AKI in lymphoma patients, with lymphocytic infiltration and cast nephropathy as notable elements contributing to the intricate nature of this condition.
Collapse
Affiliation(s)
- Wan-Ching Lee
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| |
Collapse
|
3
|
Habas E, Akbar R, Farfar K, Arrayes N, Habas A, Rayani A, Alfitori G, Habas E, Magassabi Y, Ghazouani H, Aladab A, Elzouki AN. Malignancy diseases and kidneys: A nephrologist prospect and updated review. Medicine (Baltimore) 2023; 102:e33505. [PMID: 37058030 PMCID: PMC10101313 DOI: 10.1097/md.0000000000033505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
Acute kidney injury (AKI), chronic renal failure, and tubular abnormalities represent the kidney disease spectrum of malignancy. Prompt diagnosis and treatment may prevent or reverse these complications. The pathogenesis of AKI in cancer is multifactorial. AKI affects outcomes in cancer, oncological therapy withdrawal, increased hospitalization rate, and hospital stay. Renal function derangement can be recovered with early detection and targeted therapy of cancers. Identifying patients at higher risk of renal damage and implementing preventive measures without sacrificing the benefits of oncological therapy improve survival. Multidisciplinary approaches, such as relieving obstruction, hydration, etc., are required to minimize the kidney injury rate. Different keywords, texts, and phrases were used to search Google, EMBASE, PubMed, Scopus, and Google Scholar for related original and review articles that serve the article's aim well. In this nonsystematic article, we aimed to review the published data on cancer-associated kidney complications, their pathogenesis, management, prevention, and the latest updates. Kidney involvement in cancer occurs due to tumor therapy, direct kidney invasion by tumor, or tumor complications. Early diagnosis and therapy improve the survival rate. Pathogenesis of cancer-related kidney involvement is different and complicated. Clinicians' awareness of all the potential causes of cancer-related complications is essential, and a kidney biopsy should be conducted to confirm the kidney pathologies. Chronic kidney disease is a known complication in malignancy and therapies. Hence, avoiding nephrotoxic drugs, dose standardization, and early cancer detection are mandatory measures to prevent renal involvement.
Collapse
Affiliation(s)
- Elmukhtar Habas
- Facharzt Internal Medicine, Facharzt Nephrology, Medical Department, Hamad General Hospital, Doha, Qatar
| | - Raza Akbar
- Medical Department, Hamad General Hospital, Doha, Qatar
| | - Kalifa Farfar
- Facharzt Internal Medicine, Medical Department, Alwakra General Hospital, Alwakra, Qatar
| | - Nada Arrayes
- Medical Education Fellow, Lincoln Medical School, University of Lincoln, Lincoln, UK
| | - Aml Habas
- Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | - Amnna Rayani
- Facharzt Pediatric, Facharzt Hemotoncology, Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | | | - Eshrak Habas
- Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | | | - Hafidh Ghazouani
- Quality Department, Senior Epidemiologist, Hamad Medical Corporation, Doha, Qatar
| | | | | |
Collapse
|
4
|
Jian Y, Ding G, Yang D, Du J. B‑cell lymphoblastic lymphoma‑associated renal damage: A case report and literature review. Exp Ther Med 2023; 25:85. [PMID: 36684654 PMCID: PMC9849848 DOI: 10.3892/etm.2023.11784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 01/04/2023] Open
Abstract
Lymphoblastic lymphoma (LBL) is a highly malignant form of lymphoma with rapid progression and high mortality. According to the World Health Organization immunophenotype, it is classified into T-lymphoblastic lymphoma (T-LBL) and B-lymphoblastic lymphoma (B-LBL). B-LBL often involves lymph nodes and extranodal locations, such as the skin, bones, and soft tissues. However, renal damage as an initial symptom is very rare in B-LBL. The present study presented a rare case of renal involvement in a 30-year-old male patient with B-LBL presenting with acute renal failure with bilateral renal enlargement. Renal involvement is rare in B-LBL, and nephrologists should improve the understanding of this disease.
Collapse
Affiliation(s)
- Yonghong Jian
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Guohua Ding
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Dingping Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Juan Du
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China,Correspondence to: Dr Juan Du, Department of Nephrology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
5
|
Nie G, Sun L, Zhang C, Yuan Y, Mao H, Wang Z, Li J, Duan S, Xing C, Zhang B. Clinicopathological features and individualized treatment of kidney involvement in B-cell lymphoproliferative disorder. Front Immunol 2022; 13:903315. [PMID: 36172352 PMCID: PMC9510618 DOI: 10.3389/fimmu.2022.903315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Due to the various clinical and pathological manifestations of kidney involvement in lymphoproliferative disorder (LPD), the whole spectrum of kidney disease in LPD is still unclear, and data on kidney prognosis is scarce. Methods We retrospectively reviewed the renal pathology profiles from January 2010 to December 2021, and 28 patients with B-cell LPD combined with intact renal biopsy data were included. Results There were 20 men and eight women aging 41 to 79 years at the time of renal biopsy (median age 62 years). According to hematological diagnosis, patients were classified into four groups: chronic lymphocytic leukemia (CLL) (group1, n=7), Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) (group 2, n=8; WM, n=6; LPL, n=2), Other non-Hodgkin’s lymphomas (NHL) (group3, n=7; diffuse large B-cell lymphoma (DLBCL), n=2; mucosa-associated lymphoid tissue (MALT) lymphoma, n=4; Low grade B-cell lymphoma, n=1), and monoclonal gammopathy of undetermined significance/monoclonal gammopathy of renal significance (MGUS/MGRS) (group 4, n=6). Median serum creatinine (Scr) level was 129 (range,59-956) umol/L. Eight patients (29%) were presented with acute kidney injury (AKI), and five patients (18%) required hemodialysis upon admission. Twenty-three patients (82%) presented with proteinuria (median protein excretion, 2.14 g/d), 11(39%) of whom had the nephrotic syndrome. Interstitial malignant infiltration was the most frequent renal lesion (n=6). Eight patients underwent immunohistochemistry of renal tissues, of which three patients (CLL, n=1; LPL, n=1; WM, n=1) had confirmed lymphoma infiltrates, and the infiltrating cells in the remaining five patients (CLL, n=1; MALT lymphoma, n=2; MGUS, n=2) were considered unrelated to lymphoma. The most common glomerular diseases were renal amyloidosis (n=4) and membranous nephropathy (n=4). Only 20 patients were treated, 13 of whom were treated with rituximab separately or in combination. The median follow-up time was 11 months. Of these, six had achieved hematological response, complete response in five cases. Eight had achieved renal response. At the end-of-study visit, four patients died and two progressed to end stage kidney disease (ESKD). Conclusion In conclusion, the clinicopathological spectrum of renal involvement in BLPD is diverse. Renal biopsy and immunohistochemistry are required for early diagnosis and prognostic assessment.
Collapse
Affiliation(s)
- Guangyan Nie
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lianqin Sun
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Suyan Duan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| | - Bo Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Nephrology, Pukou Branch of JiangSu Province Hospital (Nanjing Pukou Central Hospital), Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| |
Collapse
|
6
|
Gupta S, Gudsoorkar P, Jhaveri KD. Acute Kidney Injury in Critically Ill Patients with Cancer. Clin J Am Soc Nephrol 2022; 17:1385-1398. [PMID: 35338071 PMCID: PMC9625110 DOI: 10.2215/cjn.15681221] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Advances in cancer therapy have significantly improved overall patient survival; however, AKI remains a common complication in patients with cancer, occurring in anywhere from 11% to 22% of patients, depending on patient-related or cancer-specific factors. Critically ill patients with cancer as well as patients with certain malignancies (e.g., leukemias, lymphomas, multiple myeloma, and renal cell carcinoma) are at highest risk of developing AKI. AKI may be a consequence of the underlying malignancy itself or from the wide array of therapies used to treat it. Cancer-associated AKI can affect virtually every compartment of the nephron and can present as subclinical AKI or as overt acute tubular injury, tubulointerstitial nephritis, or thrombotic microangiopathy, among others. AKI can have major repercussions for patients with cancer, potentially jeopardizing further eligibility for therapy and leading to greater morbidity and mortality. This review highlights the epidemiology of AKI in critically ill patients with cancer, risk factors for AKI, and common pathologies associated with certain cancer therapies, as well as the management of AKI in different clinical scenarios. It highlights gaps in our knowledge of AKI in patients with cancer, including the lack of validated biomarkers, as well as evidence-based therapies to prevent AKI and its deleterious consequences.
Collapse
Affiliation(s)
- Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prakash Gudsoorkar
- Division of Nephrology & Kidney Clinical Advancement, Research & Education Program, University of Cincinnati, Cincinnati, Ohio
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, New York
| |
Collapse
|
7
|
Tang X, VanBeek C, Haas M, Cook HT, Zou J, Yang H, Fogo AB. Cell-Mediated Glomerulonephritis Without Immune Complexes in Native Kidney Biopsies: A Report of 7 Cases. Am J Kidney Dis 2022; 80:416-421. [PMID: 34974034 DOI: 10.1053/j.ajkd.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/07/2021] [Indexed: 02/08/2023]
Abstract
We report 7 native kidney biopsies with diffuse endocapillary hypercellularity without immune deposits, affecting 5 women and 2 men aged 52-85 years. All patients had acute kidney injury, and 4 had nephrotic-range proteinuria. Comorbidities included breast cancer in 2, pancreatitis in 1, and para-aortic lymphadenopathy and bilateral carpal tunnel syndrome in 1. Kidney biopsies were characterized by predominant T-cell and CD68-positive macrophage infiltration in glomerular capillaries without deposits. Coexisting lesions included small cellular crescents in 5, mild peritubular capillaritis in 1, mononuclear cell intimal arteritis in 1, acute tubulointerstitial nephritis in 4, and mild arteriolosclerosis in 1. During the mean follow-up duration of 24.8 months, 4 patients showed partial or complete initial remission in response to immunosuppression. However, 2 deteriorated when prednisone was rapidly tapered (1 of them achieved subsequent remission with increased prednisone). Three patients developed kidney failure. We propose that this unusual pattern of injury is mediated by abnormal cell-mediated immune response. The underlying causes and pathogenesis of this cell-mediated glomerulonephritis will require further study.
Collapse
Affiliation(s)
- Xi Tang
- Division of Nephrology, Kidney Research institute, West China Hospital of Sichuan University, Chengdu, China; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine VanBeek
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mark Haas
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - H Terence Cook
- Centre for Inflammatory Disease, Imperial College London, London, United Kingdom
| | - Jun Zou
- Division of Nephrology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haichun Yang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Agnes B Fogo
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
8
|
Narita K, Suzuki T, Matsue K. PET/CT imaging of renal intravascular large B-cell lymphoma. Clin Exp Nephrol 2022; 26:1144-1145. [PMID: 35908129 DOI: 10.1007/s10157-022-02257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan.
| | - Tomo Suzuki
- Division of Nephrology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| |
Collapse
|
9
|
Nassereldine H, Mohty R, Awada H, Abou Dalle I, El-Cheikh J, Bazarbachi A. Mantle cell lymphoma negative for t(11,14) involving the kidneys: a case report. J Med Case Rep 2022; 16:254. [PMID: 35768844 PMCID: PMC9245262 DOI: 10.1186/s13256-022-03470-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background Mantle cell lymphoma is the rarest subtype of non-Hodgkin’s lymphoma. It can exhibit diverse extranodal manifestations. However, renal involvement is uncommon, and if it occurs, it usually only gets detected postmortem. There are several mechanisms by which mantle cell lymphoma can damage the kidneys. Renal failure is a potential complication, and prompt evaluation and diagnosis are critical steps to prevent long-term complications. Case presentation We present the case of a 75-year-old non-Hispanic White male with past medical history significant for hypertension and dyslipidemia, presenting with fever, weight loss, and night sweats. Work-up showed markedly elevated white blood cells, multiple enlarged lymph nodes, and a kidney mass. The patient was diagnosed with mantle cell lymphoma with kidney involvement confirmed with a kidney biopsy. His disease was positive for cyclin D1 overexpression despite t(11; 14) absence. The patient received six cycles of alternating vincristine, rituximab, cyclophosphamide, doxorubicin, and prednisone then dexamethasone, high-dose cytarabine, and oxaliplatin, after which he was maintained on ibrutinib and rituximab, with resolution of symptoms and disease regression. Conclusion We present a case of a rare presentation of Mantle cell lymphoma while describing the clinical presentation and diagnostic and treatment approaches. This case report can assist physicians in the clinical work-up and treatment of patients with similar diagnosis or presentation.
Collapse
Affiliation(s)
| | - Razan Mohty
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044, Beirut, Lebanon
| | - Hussein Awada
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Iman Abou Dalle
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044, Beirut, Lebanon
| | - Jean El-Cheikh
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044, Beirut, Lebanon
| | - Ali Bazarbachi
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044, Beirut, Lebanon.
| |
Collapse
|
10
|
Abramson M, Mehdi A. Hematological Malignancies and the Kidney. Adv Chronic Kidney Dis 2022; 29:127-140.e1. [PMID: 35817520 DOI: 10.1053/j.ackd.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
The incidence of hematologic malignancies is on the rise worldwide. Kidney disease is ubiquitous in patients with hematologic malignancies, encompassing a wide spectrum of disorders involving each kidney compartment, including the vasculature, tubules, interstitium, and glomerulus, and there is significant overlap of kidney involvement with each hematologic malignancy. Vascular disorders include both microvascular and macrovascular damage, via thrombotic microangiopathy, hyperleukocytosis, hyperviscosity, and cryoglobulinemia. The tubulointerstitial compartment may be affected by prerenal azotemia and acute tubular injury, but malignant infiltration, tumor lysis syndrome, extramedullary hematopoiesis, cast nephropathy, granulomatous interstitial nephritis, and lysozymuria should be considered in certain populations. Obstructive uropathy may occur due to nephrolithiasis or retroperitoneal fibrosis. Glomerular disorders, including membranoproliferative, membranous, minimal change, and focal segmental glomerulosclerosis, can rarely occur. By understanding how each compartment may be affected, care can best be optimized for these patients. In this review, we summarize the widely varied etiologies of kidney diseases stratified by kidney compartment and hematologic malignancy, focusing on demographics, pathology, pathophysiology, mechanism, and outcomes. We conclude with common electrolyte abnormalities associated with hematologic malignancies.
Collapse
|
11
|
Swain M, Nuguri S, De Padua M, Gowrishankar S. Renal lymphoma diagnosed on kidney biopsy presenting as acute kidney injury. Indian J Nephrol 2022; 32:342-347. [PMID: 35967526 PMCID: PMC9364996 DOI: 10.4103/ijn.ijn_345_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction: Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal. Methods: This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury. Results: The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1–9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis. Conclusion: Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.
Collapse
|
12
|
Gudsoorkar P, Langote A, Vaidya P, Meraz-Muñoz AY. Acute Kidney Injury in Patients With Cancer: A Review of Onconephrology. Adv Chronic Kidney Dis 2021; 28:394-401.e1. [PMID: 35190106 DOI: 10.1053/j.ackd.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Abstract
Over the past 2 decades, significant research and advancements have been made in oncology and its therapeutics. Thanks to novel diagnostic methods, treatments, and supportive measures, patients with cancer live longer and have a better quality of life. However, an unforeseen consequence of this progress has been increasing medical complications, including acute kidney injury. The purpose of this review is to provide an overview of the epidemiology and most common causes of acute kidney injury in patients with cancer unrelated to oncological treatment.
Collapse
|
13
|
Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits. Diagnostics (Basel) 2021; 11:diagnostics11040710. [PMID: 33921123 PMCID: PMC8071536 DOI: 10.3390/diagnostics11040710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.
Collapse
|
14
|
Bridoux F, Cockwell P, Glezerman I, Gutgarts V, Hogan JJ, Jhaveri KD, Joly F, Nasr SH, Sawinski D, Leung N. Kidney injury and disease in patients with haematological malignancies. Nat Rev Nephrol 2021; 17:386-401. [PMID: 33785910 DOI: 10.1038/s41581-021-00405-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is common in patients with cancer, especially in those with haematological malignancies. Kidney injury might be a direct consequence of the underlying haematological condition. For example, in the case of lymphoma infiltration or extramedullary haematopoiesis, it might be caused by a tumour product; in the case of cast nephropathy it might be due to the presence of monoclonal immunoglobulin; or it might result from tumour complications, such as hypercalcaemia. Kidney injury might also be caused by cancer treatment, as many chemotherapeutic agents are nephrotoxic. High-intensity treatments, such as high-dose chemotherapy followed by haematopoietic stem cell transplantation, not only increase the risk of infection but can also cause AKI through various mechanisms, including viral nephropathies, engraftment syndrome and sinusoidal obstruction syndrome. Some conditions, such as thrombotic microangiopathy, might also result directly from the haematological condition or the treatment. Novel immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T cell therapy, can also be nephrotoxic. As new therapies for haematological malignancies with increased anti-tumour efficacy and reduced toxicity are developed, the number of patients receiving these treatments will increase. Clinicians must gain a good understanding of the different mechanisms of kidney injury associated with cancer to better care for these patients.
Collapse
Affiliation(s)
- Frank Bridoux
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France.,CNRS, UMR7276, Limoges, France.,Centre de référence Amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales, Poitiers, France
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ilya Glezerman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Victoria Gutgarts
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Jonathan J Hogan
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Florent Joly
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
15
|
Meraz-Munoz A, Langote A, Jhaveri KD, Izzedine H, Gudsoorkar P. Acute Kidney Injury in the Patient with Cancer. Diagnostics (Basel) 2021; 11:611. [PMID: 33805529 PMCID: PMC8065801 DOI: 10.3390/diagnostics11040611] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/18/2023] Open
Abstract
Over the last three decades, advancements in the diagnosis, treatment, and supportive care of patients with cancer have significantly improved their overall survival. However, these advancements have also led to a higher rate of cancer-related complications. Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in patients with cancer, and they are associated with an increased risk of all-cause mortality. This bidirectional interplay between cancer and kidney, termed "the kidney-cancer connection" has become a very active area of research. This review aims to provide an overview of some of the most common causes of AKI in patients with cancer. Cancer therapy-associated AKI is beyond the scope of this review and will be discussed separately.
Collapse
Affiliation(s)
- Alejandro Meraz-Munoz
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
| | - Amit Langote
- Consultant Nephrologist, Apollo Hospital, Navi Mumbai, Maharashtra 400614, India;
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, NY 11021, USA;
| | - Hassane Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, 75013 Paris, France;
| | - Prakash Gudsoorkar
- Division of Nephrology & Kidney Clinical Advancement, Research & Education Program, University of Cincinnati, Cincinnati, OH 45267, USA
| |
Collapse
|
16
|
Cheung CY, Tang AHC, Wong YT, Chan GSW, Tang SCW. Clinicopathological features of Chinese patients with B-cell lymphoproliferative disorders and kidney infiltration. Nephrology (Carlton) 2021; 26:650-658. [PMID: 33729651 DOI: 10.1111/nep.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022]
Abstract
AIM Direct kidney involvement in B-cell lymphoproliferative disease is a rare disorder with only a few studies reported in Caucasian patients. The clinicopathological characteristics and outcome of this entity remain poorly described. METHODS We retrospectively studied all adult Chinese patients who had histology-proven renal parenchymal infiltration by malignant B-cells between 1 January 2000 and 31 December 2018 at two tertiary hospitals in Hong Kong. Clinical, pathological and radiological data were collected from 20 patients. Follow-up data were analysed until 31 December 2019. RESULTS Median follow-up duration was 22 (1-171) months. Only seven patients (35%) had established diagnosis of haematological cancer before kidney biopsy. Diffuse large B-cell lymphoma (DLBCL) was the most common subtype in our cohort (n = 5, 25%). Others included low-grade B-cell lymphoma (n = 11), intravascular large B-cell lymphoma (n = 1), mantle cell lymphoma (n = 1) and multiple myeloma (n = 2). Fourteen patients (70%) presented with AKI while 12 patients (60%) had proteinuria. Seven patients (35%) had unilateral renal mass, one had bilateral renal masses and one had bilateral diffuse nephromegaly in computed tomography. Lymphomatous tubulointerstitial infiltration was the prevalent histological finding. Nine patients (45%) had coexisting renal lesions other than direct tumour infiltration. All but one patient received chemotherapy. Ten patients died and renal responders had a significantly better survival than non-renal responders (p = .03). CONCLUSION Direct tumour infiltration can occur in a wide variety of B-cell lymphoproliferative disorders. Coexisting immunoglobulin-related nephropathy is frequently found. Renal biopsy is required for early diagnosis which allows timely and appropriate treatment.
Collapse
Affiliation(s)
- Chi Yuen Cheung
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Arthur H C Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yuen Ting Wong
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Gavin S W Chan
- Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| |
Collapse
|
17
|
Renal intravascular large B-cell lymphoma predominantly localized in peritubular capillaries. CEN Case Rep 2021; 10:383-387. [PMID: 33537904 DOI: 10.1007/s13730-020-00570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
We report on a 70-year-old woman with intravascular large B-cell lymphoma, in whom the renal lesion was localized in the peritubular capillaries. The patient complained of fatigue, general malaise, and unsteadiness when walking. Laboratory tests showed anemia, increased C-reactive protein, and mild renal failure, with a serum creatinine level of 1.31 mg/dL and no remarkable proteinuria or hematuria. Renal biopsy showed intravascular large B-cell lymphoma. The large atypical cells were mainly accumulated within the peritubular capillaries and no large atypical cells were found in the glomeruli. Skin and bone marrow biopsies confirmed intravascular large B-cell lymphoma. Brain magnetic resonance imaging showed multiple small infarctions in the cerebral white matter. The patient was treated with dexamethasone, methotrexate, and cytarabine followed by CHOP (combined cyclophosphamide, doxorubicin, vincristine, and prednisone) and R-CHOP (CHOP with the recombinant anti-CD20 antibody rituximab), and her renal function improved soon after the start of chemotherapy.
Collapse
|
18
|
Isnard P, Linster C, Bruneau J, Thervet E, Duong Van Huyen JP, Rossignol J, Karras A, Chauvet S, Rabant M. Natural Killer Cell Large Granular Lymphocyte Leukemia-Induced Glomerulonephritis. Kidney Int Rep 2021; 6:1174-1177. [PMID: 33912766 PMCID: PMC8071643 DOI: 10.1016/j.ekir.2021.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pierre Isnard
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Charel Linster
- Department of Nephrology, Européen Georges Pompidou Hospital, APHP, Paris, France
| | - Julie Bruneau
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Eric Thervet
- Université de Paris, Paris, France.,Department of Nephrology, Européen Georges Pompidou Hospital, APHP, Paris, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Campus, Paris, France
| | - Alexandre Karras
- Université de Paris, Paris, France.,Department of Nephrology, Européen Georges Pompidou Hospital, APHP, Paris, France
| | - Sophie Chauvet
- Université de Paris, Paris, France.,Department of Nephrology, Européen Georges Pompidou Hospital, APHP, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| |
Collapse
|
19
|
Limited Renal Intravascular Lymphoma: A Case Report and Review of the Literature. Case Rep Oncol Med 2020; 2020:7052536. [PMID: 33083073 PMCID: PMC7563074 DOI: 10.1155/2020/7052536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/07/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. It is characterized by the proliferation of cancerous cells into the intraluminal space of the blood vessels. It has a low incidence rate of 0.095 cases per 1,000,000. The clinical presentation is insidious and unspecific, often delaying the diagnosis. IVLBCL can be diagnosed through body images and histopathology analysis. This neoplasm averages a 60% response rate to current chemotherapy treatment, favoring rituximab, and doxorubicin-based regimen if it is diagnosed in time. Here, we present the case of a 56-year-old man admitted to our hospital with a fever who was eventually diagnosed with IVLBCL. He presented to the consultation with anemia, fever, and splenomegaly. An infection panel, a bone marrow biopsy, and a PET-CT scan were performed and ruled out the possibility of infections and neoplasms. The patient later developed edematous syndrome. As a result, a renal biopsy was performed which tested positive for intravascular large B-cell lymphoma. Currently, the patient has been in complete remission for 33 months. Along with presenting this specific case, we also reviewed previously published cases of IVLBCL to illustrate the renal involvement of this pathology.
Collapse
|
20
|
L'Imperio V, Rossi M, Abdul A, Mehta SR, Shaver AC, Fogo AB. Lymphoma and the Kidney: A Kidney Biopsy Teaching Case. Kidney Med 2020; 2:663-666. [PMID: 33089144 PMCID: PMC7568066 DOI: 10.1016/j.xkme.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lymphomatous infiltration of kidney parenchyma is a frequent complication of systemic hematologic malignancies and often shows subtle clinical presentation. Diffuse large B-cell lymphoma represents the most frequent form involving the kidney, with advanced stage at diagnosis, poor outcome, and risk for central nervous system relapse if not adequately treated. Kidney biopsy can provide specific and early detection of these cases, helping in the differential diagnosis with more frequent entities. Finally, further hematologic workup (bone marrow biopsy, complete blood cell count, and positron emission tomography) can distinguish secondary involvement of the kidney from the rarer kidney-limited forms, especially in patients without a previous diagnosis of lymphoma. Making a prompt and correct diagnosis directs the management of these cases and may improve the outcome, as described in the present report.
Collapse
Affiliation(s)
- Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Mattia Rossi
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.,Renal Unit, Department of Medicine, University and Hospital of Verona, Verona, Italy
| | - Afu Abdul
- Nephrology, Harbin Clinic, Cartersville, GA
| | - Satyen R Mehta
- Hematology, Northwest Georgia Oncology Center, Cartersville, GA
| | - Aaron C Shaver
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
21
|
Mir TH, Sharma A, Nisar S, Khan AA, Shah TA, Wani NA. Acute Kidney Injury With Massively Enlarged Noncystic Kidneys. Am J Kidney Dis 2020; 75:A15-A17. [PMID: 32331578 DOI: 10.1053/j.ajkd.2019.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/09/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Tajamul H Mir
- Department of Nephrology, Khyber Medical Institute, Nowpora, Srinagar, India
| | - Alok Sharma
- Department of Renal Pathology, Dr Lal PathLab/National Reference Laboratory, New Delhi, India
| | - Syed Nisar
- Department of Medical Oncology, Khyber Medical Institute, Nowpora, Srinagar, India
| | - Afaaq A Khan
- Department of Clinical Hematology, Khyber Medical Institute, Nowpora, Srinagar, India
| | - Tabinda A Shah
- Department of Nephrology, Khyber Medical Institute, Nowpora, Srinagar, India
| | - Nisar A Wani
- Department of Radiodiagnosis, Khyber Medical Institute, Nowpora, Srinagar, India
| |
Collapse
|
22
|
Kohn M, Karras A, Zaidan M, Bénière C, de Fréminville JB, Laribi K, Perrin MC, Malphettes M, Le Calloch R, Anglaret B, Martiniuc J, Bailly S, Chevret S, Molina T, Thervet E, Thieblemont C. Lymphomas with kidney involvement: the French multicenter retrospective LyKID study. Leuk Lymphoma 2020; 61:887-895. [PMID: 32037948 DOI: 10.1080/10428194.2019.1697811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The LyKID study is a nationwide survey in France of lymphoma patients with renal involvement based on biopsy and/or imaging, to evaluate its impact on disease outcome and renal function. A total of 87 adult cases of B or T-cell lymphomas were retrospectively analyzed. Interstitial topography was observed in most of the kidney biopsies (54/66; 80%). Kidney failure (glomerular filtration rate <60 mL/min/1.73 m2) was present in 47% of patients and was associated with non-significantly different outcome. After lymphoma treatment, 44% of patients had persistent chronic kidney failure (CKF); kidney failure at diagnosis was the only parameter associated with CKF in multivariate analysis. DLBCL (diffuse large B-cell lymphomas) represented half of the series, with noticeably CNS (central neurological system) relapse in 17% patients, while fewer than one of two patients had received CNS prophylaxis. To our knowledge, the LyKID study represents the largest published non-autopsy lymphoma series with renal involvement.
Collapse
Affiliation(s)
- Milena Kohn
- Hémato-Oncologie, APHP, Hôpital Saint-Louis, Paris, France
| | - Alexandre Karras
- Néphrologie, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | | | | | | | | | | | - Marion Malphettes
- Immuno-Pathologie Clinique, APHP, Hôpital Saint-Louis, Paris, France
| | - Ronan Le Calloch
- Service des Maladies du Sang, Médecine Interne, Maladies Infectieuses, CH de Quimper Cornouailles, Quimper, France
| | | | | | - Sarah Bailly
- Hématologie, Cliniques Universitaires Saint Luc Université catholique de Louvain, Bruxelles, Belgium
| | - Sylvie Chevret
- Biostatistiques, APHP, Hôpital Saint-Louis, Paris, France
| | | | - Eric Thervet
- Néphrologie, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | | |
Collapse
|
23
|
Margolskee EM, Salvatore SP, Geyer JT. Lymphoid Neoplasms of the Kidney. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Samarasinghe A, Wong D, Cull G, Chakera A. Marginal zone lymphoma causing accelerated progression of chronic kidney disease. BMJ Case Rep 2019; 12:12/11/e230270. [PMID: 31712228 PMCID: PMC6855851 DOI: 10.1136/bcr-2019-230270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 75-year-old man with stage IV chronic kidney disease due to type 2 diabetes mellitus, presented with increasing proteinuria and rapidly declining renal function despite excellent glycaemic control. Investigations organised to assess his suitability for renal transplantation included an abdominal CT scan, which revealed extensive intra-abdominal lymphadenopathy. A 17fluorodeoxyglucose (FDG)-positron emission tomography scan to further characterise the lymphadenopathy demonstrated activity in the lymph nodes, as well as both kidneys. Following a lymph node biopsy and flow cytometry he was diagnosed with a marginal zone lymphoma. A subsequent kidney biopsy confirmed lymphomatous infiltration of the kidney. Marginal zone lymphoma is an uncommon type of non-Hodgkin's lymphoma, and renal involvement is rare. This case highlights the importance of considering alternative diagnoses when there is deviation from the expected clinical trajectory and the importance of liaising with colleagues in other disciplines to enable an accurate diagnosis to be made.
Collapse
Affiliation(s)
- Amali Samarasinghe
- Medical, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Daniel Wong
- Pathology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gavin Cull
- Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Aron Chakera
- Renal, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
25
|
Javaugue V, Debiais-Delpech C, Nouvier M, Gand E, Chauvet S, Ecotiere L, Desport E, Goujon JM, Delwail V, Guidez S, Tomowiak C, Leleu X, Jaccard A, Rioux-Leclerc N, Vigneau C, Fermand JP, Touchard G, Thierry A, Bridoux F. Clinicopathological spectrum of renal parenchymal involvement in B-cell lymphoproliferative disorders. Kidney Int 2019; 96:94-103. [PMID: 30987838 DOI: 10.1016/j.kint.2019.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 01/25/2023]
Abstract
The clinicopathological characteristics of kidney infiltration in B-cell lymphoproliferative disorders remain poorly described. We retrospectively studied 52 adults with biopsy-proven malignant B-cell kidney infiltration, including Waldenström's macroglobulinemia (n=21), chronic lymphocytic leukemia (n=11), diffuse large B-cell lymphoma (DLBCL) (n=8), other lymphoma (n=11), and multiple myeloma (n=1). Kidney disease varied according to the underlying lymphoproliferative disorder. In DLBCL, malignant kidney infiltration was prominent, resulting in acute kidney injury (AKI, 75%) and kidney enlargement (88%). In the other types, associated immunoglobulin-related nephropathy (most commonly AL amyloidosis) was more common (45%), and chronic kidney disease with proteinuria was the primary presentation. All patients received chemotherapy. Over a median follow-up of 31 months, 20 patients died and 21 reached end-stage kidney disease. Renal response, achieved in 25 patients (48%), was associated with higher overall survival (97 vs. 37 months in non-renal responders). In univariate analysis, percentage of sclerotic glomeruli, kidney enlargement, and complete hematological response at 6 months were predictive of renal response. In multivariate analysis, concomitant immunoglobulin-related nephropathy was the sole independent predictor of poor renal outcome. In conclusion, clinical presentation of renal lymphomatous infiltration depends on the nature of the underlying lymphoproliferative disorder. In DLBCL, massive renal infiltration manifests with enlarged kidneys and AKI, and the diagnosis primarily relies on lymph node biopsy. In other B-cell lymphoproliferative disorders, the clinicopathological spectrum is more heterogeneous, with a high frequency of immunoglobulin-related nephropathy that may affect renal outcome; thus kidney biopsy is required for early diagnosis and prognostic assessment.
Collapse
Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Céline Debiais-Delpech
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Mathilde Nouvier
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Elise Gand
- INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| | - Sophie Chauvet
- INSERM UMR 1138, Centre de Recherche des Cordeliers, Complement and Diseases Team, Paris, France; Assistance Publique Hôpitaux de Paris, Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Laure Ecotiere
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Vincent Delwail
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Department of Hematology, Centre Hospitalier Universitaire, Université de Limoges, Limoges, France
| | | | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire, Rennes, France; CNRS UMR 6290, Université Rennes 1, France
| | | | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; INSERM UMR 1082, Centre Hospitalier Universitaire, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| |
Collapse
|
26
|
Corlu L, Rioux-Leclercq N, Ganard M, Decaux O, Houot R, Vigneau C. Renal Dysfunction in Patients With Direct Infiltration by B-Cell Lymphoma. Kidney Int Rep 2019; 4:688-697. [PMID: 31080924 PMCID: PMC6506703 DOI: 10.1016/j.ekir.2019.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/29/2022] Open
Abstract
Background B-cell lymphoproliferative disorders with renal involvement are relatively frequent, but remain poorly described. A kidney biopsy is usually required to detect the renal lesions that are often missed using other diagnostic tools. Methods We retrospectively identified 34 patients with renal lymphoma diagnosed by percutaneous kidney biopsy (PKB) at Rennes University Hospital and its affiliated hospital centers between January 1, 2004, and May 1, 2016. Clinical, biological, radiological, and histological characteristics were collected at biopsy time. Results The included patients had Waldenström macroglobulinemia (n = 12; 35.3%), chronic lymphocytic leukemia/lymphocytic lymphoma (n = 10; 29.5%), high-grade B-cell lymphoma (n = 6; 17.6%), and low-grade B-cell lymphoma (n = 6; 17.6%). The median follow-up was 29 months. Renal involvement led to renal function impairment in 29 patients (85.3%), among whom 20 had acute kidney injury (70%), and to nephrotic syndrome in 4 patients (11.8%). Only 13 patients (38.2%) presented morphological kidney anomalies among whom 5 showed bilateral infiltration. Histologically, interstitial infiltrate (97.1%) was the most common kidney lesion, and 9 patients (26.5%) had specific lymphomatous intraglomerular lesions. After hematological treatment (n = 29), a renal response was observed only in 8 patients (27.6%). Conclusion Renal involvement in the context of B-cell lymphoproliferative disorders is not uncommon. PKB is the best method to confirm this diagnosis. It should be performed early to rapidly initiate the hematological treatment to preserve kidney function.
Collapse
Affiliation(s)
- Lea Corlu
- CHU de Rennes, Service de Néphrologie, Rennes, France
| | | | - Michel Ganard
- CHU de Rennes, Service d'Hématologie, Rennes, France
| | - Olivier Decaux
- CHU de Rennes, Service de Médecine Interne, Rennes, France
| | - Roch Houot
- CHU de Rennes, Service d'Hématologie, Rennes, France
| | - Cécile Vigneau
- CHU de Rennes, Service de Néphrologie, Rennes, France.,CHU de Rennes, Service d'Anatomo-cytopathologie, Rennes, France.,CHU de Rennes, Service d'Hématologie, Rennes, France.,CHU de Rennes, Service de Médecine Interne, Rennes, France.,IRSET, Rennes, France
| |
Collapse
|
27
|
Uppal NN, Monga D, Vernace MA, Mehtabdin K, Shah HH, Bijol V, Jhaveri KD. Kidney diseases associated with Waldenström macroglobulinemia. Nephrol Dial Transplant 2018; 34:1644-1652. [DOI: 10.1093/ndt/gfy320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023] Open
Abstract
AbstractWaldenström macroglobulinemia (WM) is a rare B-cell lymphoma characterized by lymphoplasmacytic cell infiltration in the bone marrow and other organs and the presence of a monoclonal immunoglobulin M protein in the serum. Although uncommon, several kidney diseases have been associated with WM. In addition to kidney diseases related to lymphoplasmacytic lymphoma infiltration, a variety of glomerular and tubular lesions have been described in patients with WM. Immunoglobulin light chain (AL) amyloidosis and cryoglobulinemic glomerulonephritis are the two predominant glomerular pathologies seen in WM. In this article we review the kidney diseases associated with WM. We also briefly review some nephrotoxicities of novel chemotherapeutic and targeted therapies used for the treatment of WM.
Collapse
Affiliation(s)
- Nupur N Uppal
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Divya Monga
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Khurram Mehtabdin
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Hitesh H Shah
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Vanesa Bijol
- Department of Pathology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
28
|
Dhillon P, Amir E, Lo M, Kitchlu A, Chan C, Cochlin S, Yip P, Chen E, Lee R, Ng P. A case–control study analyzing mannitol dosing for prevention of cisplatin-induced acute nephrotoxicity. J Oncol Pharm Pract 2018; 25:875-883. [DOI: 10.1177/1078155218771461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mannitol is an osmotic diuretic given routinely as part of cisplatin regimens to prevent nephrotoxicity, but there are limited data on the ideal dosage. At our center, three different doses of mannitol are used: 12, 20, and 40 g per cycle for cisplatin doses of ≥50 mg/m2. The primary objective was to determine if variations in mannitol dosing significantly influence the incidence of cisplatin-induced acute nephrotoxicity. Methods A case–control study was performed. Electronic records of 1462 consecutive outpatients who received cisplatin at ≥ 50 mg/m2 per cycle between January 2010 and December 2014 were reviewed. Patients experiencing nephrotoxicity of any grade within 30 days of last cisplatin dose, as defined by NCI CTCAE 4.0, were matched to a minimum of two and maximum of five controls based on the following criteria: age ± 5 years, baseline estimated glomerular filtration rate ± 10 ml/min/1.73 m2, cisplatin dose per cycle, and presence of diabetes. Conditional logistic regression was used to identify baseline predictors of cisplatin-induced acute nephrotoxicity. Results Of the 1245 included patients, 237 had nephrotoxicity and 1008 were matched controls. Median baseline estimated glomerular filtration rate for cases and controls were 83 and 80 ml/min/1.73 m2, respectively. A total of 3.8% of cases experienced ≥ grade 3 nephrotoxicity. Univariable analysis showed that diabetes, lymphoma, low baseline estimated glomerular filtration rate, and low baseline magnesium level were significantly associated with nephrotoxicity, whereas mannitol dosing did not show any association (odds ratio 1.08; p = 0.29). In multivariable analysis, diabetes and lymphoma retained statistical significance, but baseline estimated glomerular filtration rate and baseline magnesium level showed nonsignificant associations with nephrotoxicity. Conclusions Cisplatin-induced acute nephrotoxicity remains common in patients with good baseline renal function despite preventive measures. Diabetes and lymphoma are predictors of nephrotoxicity, whereas mannitol dosing has no significant influence, suggesting that doses may be standardized across cisplatin regimens.
Collapse
Affiliation(s)
- Patwant Dhillon
- Department of Pharmacy, Princess Margaret Cancer Centre, UHN, Toronto, Canada
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melissa Lo
- Department of Pharmacy, Princess Margaret Cancer Centre, UHN, Toronto, Canada
| | - Abhijat Kitchlu
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Nephrology, Toronto General Hospital, UHN, Toronto, Canada
| | - Christopher Chan
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Nephrology, Toronto General Hospital, UHN, Toronto, Canada
| | - Stephen Cochlin
- Laboratory Medicine Program, Toronto General Hospital, UHN, Toronto, Canada
| | - Paul Yip
- Laboratory Medicine Program, Toronto General Hospital, UHN, Toronto, Canada
| | - Eric Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Roy Lee
- Department of Pharmacy, Princess Margaret Cancer Centre, UHN, Toronto, Canada
| | - Pamela Ng
- Department of Pharmacy, Princess Margaret Cancer Centre, UHN, Toronto, Canada
| |
Collapse
|
29
|
Abstract
Few cases of IgA nephropathy with angioimmunoblastic T-cell lymphoma (AITL) have been reported. We herein present the case of a 79-year-old Japanese man with AITL and IgA nephropathy. The patient presented with generalized edema, fatigue, and fever. Laboratory investigations revealed polyclonal gammopathy with a high level of IgA, microscopic hematuria, proteinuria, and some other immunological abnormalities. Computed tomography revealed generalized lymphadenopathy. A diagnosis of AITL and IgA nephropathy was made based on inguinal lymph node and renal biopsies. Following chemotherapy for AITL, the patient's edema, microscopic hematuria, and proteinuria were alleviated. These findings indicate that IgA nephropathy may occur in AITL patients.
Collapse
Affiliation(s)
- Yukinori Harada
- Department of Internal Medicine, Nagano Chuo Hospital, Japan
| | | | | | | |
Collapse
|
30
|
Desclaux A, Lazaro E, Pinaquy JB, Yacoub M, Viallard JF. Renal Intravascular Large B-cell Lymphoma: A Case Report and Review of the Literature. Intern Med 2017; 56:827-833. [PMID: 28381751 PMCID: PMC5457928 DOI: 10.2169/internalmedicine.56.6406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We herein report the case of a 52-year-old woman who consulted us because of a 2-month history of a fever, anorexia and weight loss. A physical examination was unremarkable. The blood count showed mild anemia and lymphopenia, and lactate dehydrogenase was elevated. Creatinine clearance was normal and proteinuria was undetectable. CT showed enlarged kidneys. A bone marrow biopsy was normal. PET-CT showed an intense uptake of 18fluorodeoxyglucose in both kidneys. A kidney biopsy provided the diagnosis of intravascular large B-cell lymphoma (IVLBCL). Kidney-limited IVLBCL without an impairment in the renal function or proteinuria has not been described. We analyzed the 38 published cases of IVLBCL involving the kidney to describe the main features of this entity.
Collapse
Affiliation(s)
- Arnaud Desclaux
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, France
| | | | | | | | | |
Collapse
|
31
|
Hundsdoerfer P, Querfeld U. Refractory arterial hypertension and renal failure combined with cerebral seizures and pancytopenia in a 5-year-old girl with bilateral nephromegaly: Answers. Pediatr Nephrol 2016; 31:1613-4. [PMID: 26260381 DOI: 10.1007/s00467-015-3183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Patrick Hundsdoerfer
- Department of Pediatric Hematology, Oncology Charité, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Uwe Querfeld
- Department of Pediatric Nephrology, Charité, Berlin, Germany
| |
Collapse
|
32
|
Rajakumar V, Balaraman V, Balasubramaniam R, Shankar S, Ganesan TS, Kurien AA. Lymphoblastic lymphoma presenting as bilateral renal enlargement diagnosed by percutaneous kidney biopsy: Report of three cases. Indian J Nephrol 2016; 26:298-301. [PMID: 27512306 PMCID: PMC4964694 DOI: 10.4103/0971-4065.179368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Renal involvement by lymphoma can be a diagnostic challenge. Acute kidney injury (AKI) is an unusual manifestation of lymphomatous infiltration in the kidneys. We report three cases of lymphoblastic lymphoma, a very rare form of lymphoma, presenting with AKI and bilateral enlargement of kidneys, diagnosed by percutaneous kidney biopsy. Lymphomatous infiltration should be suspected with such clinical presentation. Kidney biopsy is a valuable diagnostic tool, to establish the correct diagnosis and subtype of lymphoma for timely initiation of therapy for these aggressive hematological malignancies.
Collapse
Affiliation(s)
- V Rajakumar
- Department of Nephrology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - V Balaraman
- Department of Nephrology, Aysha Hospital, Chennai, Tamil Nadu, India
| | - R Balasubramaniam
- Department of Nephrology, Kauvery Hospital, Chennai, Tamil Nadu, India
| | - S Shankar
- Department of Nephrology, Davita Nephrolife, Chennai, Tamil Nadu, India
| | - T S Ganesan
- Department of Medical Oncology, Cancer Institute, Chennai, Tamil Nadu, India
| | - A A Kurien
- Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
| |
Collapse
|
33
|
Attias P, Moktefi A, Matignon M, Dupuis J, Debiais-Delpech C, Grimbert P, Lang P, Audard V. Monotypic plasma cell interstitial nephritis as the only clinical manifestation in a patient with previously undiagnosed indolent multiple myeloma: A case report. Medicine (Baltimore) 2016; 95:e4391. [PMID: 27495052 PMCID: PMC4979806 DOI: 10.1097/md.0000000000004391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Predominantly monotypic plasma cell infiltrates are an uncommon renal finding in patients with malignant lymphoplasmacytic proliferation. CASE PRESENTATION We report the case of a 52-year-old man with chronic kidney disease and significant proteinuria associated with a monoclonal immunoglobulin spike (IgGκ). Kidney biopsy revealed the presence of atypical multinucleated CD138 plasma cells with voluminous nuclei stained exclusively with a κ antibody. Electron microscopy showed mesangial and segmental parietal electron-dense, nonorganized hyaline deposits without immunogold labeling for the κ light chain. The bone marrow aspirate revealed 6% of apparently mature plasmocytes without dystrophy. We therefore concluded that the patient had an indolent multiple myeloma with specific renal involvement in the form of malignant monotypic interstitial plasmacytic infiltration. We initiated a specific chemotherapy regimen including bortezomib-cyclophosphamide-dexamethasone. After 4 months of follow-up, creatinine levels had improved slightly and free κ light-chain levels had decreased significantly within the normal range. CONCLUSION This case highlights the need to consider neoplastic interstitial plasma cell infiltration systematically in patients diagnosed with an apparently benign monoclonal gammopathy and to consider adaptation of the chemotherapy regimen, to improve renal function.
Collapse
Affiliation(s)
- Philippe Attias
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri–Mondor/Albert-Chenevier
| | - Anissa Moktefi
- AP-HP, Département de Pathologie, Groupe Hospitalier Henri-Mondor/Albert-Chenevier
- Université Paris-Est-Créteil (UPEC), Département Hospitalo-Universitaire (DHU) Virus-Immunité-Cancer (VIC), Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, INSERM U 955
| | - Marie Matignon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri–Mondor/Albert-Chenevier
- Université Paris-Est-Créteil (UPEC), Département Hospitalo-Universitaire (DHU) Virus-Immunité-Cancer (VIC), Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, INSERM U 955
| | - Jehan Dupuis
- AP-HP, Unité d’Hémopathies Lymphoïdes, Groupe Hospitalier Henri-Mondor/Albert-Chenevier
- UPEC, DHU VIC, IMRB, Equipe 9, INSERM U 955, Créteil
| | - Céline Debiais-Delpech
- Centre de Référence des Amyloses Primitives et des Maladies de Dépôts d’Immunoglobulines Monoclonales
- Département de Pathologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Philippe Grimbert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri–Mondor/Albert-Chenevier
- Université Paris-Est-Créteil (UPEC), Département Hospitalo-Universitaire (DHU) Virus-Immunité-Cancer (VIC), Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, INSERM U 955
| | - Philippe Lang
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri–Mondor/Albert-Chenevier
- Université Paris-Est-Créteil (UPEC), Département Hospitalo-Universitaire (DHU) Virus-Immunité-Cancer (VIC), Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, INSERM U 955
| | - Vincent Audard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri–Mondor/Albert-Chenevier
- Université Paris-Est-Créteil (UPEC), Département Hospitalo-Universitaire (DHU) Virus-Immunité-Cancer (VIC), Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, INSERM U 955
- Correspondence: Vincent Audard, Service de Néphrologie et Transplantation, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, 51, Avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil Cedex, France (e-mail: )
| |
Collapse
|
34
|
Lloyd IE, Khalighi MA. Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration. Am J Kidney Dis 2016; 68:640-644. [PMID: 27337992 DOI: 10.1053/j.ajkd.2016.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/04/2016] [Indexed: 11/11/2022]
Abstract
Kidney injury can be a complication of hematopoietic neoplasia by both direct and indirect mechanisms. Virtually all lymphomas and plasma cell dyscrasias can show kidney involvement, including parenchymal infiltration and by secondary injury. Recently, a unique form of glomerulonephritis with masked monotypic immunoglobulin deposits has been reported, which shows frequent association with hematopoietic neoplasia and a propensity for progressive kidney disease. In many instances, these cases are likely diagnosed as glomerulonephritis with dominant C3 due to the absence of immunoglobulin staining by routine immunofluorescence microscopy. The patient reported here showed lymphomatous infiltration on kidney biopsy and mesangial proliferative glomerulonephritis with dominant staining for C3 without immunoglobulins on initial immunofluorescence; however, monotypic immunoglobulin G κ light chain was revealed after additional immunofluorescence staining was performed on the paraffin-embedded tissue. This patient's case highlights the evolving state of kidney biopsy interpretation and the expanding spectrum of kidney disease in the setting of hematopoietic neoplasia.
Collapse
Affiliation(s)
- Isaac E Lloyd
- Department of Pathology, University of Utah, Salt Lake City, UT
| | | |
Collapse
|
35
|
ter Haar E, Labarque V, Tousseyn T, Mekahli D. Severe acute kidney injury as presentation of Burkitt's lymphoma. BMJ Case Rep 2016; 2016:bcr-2016-214780. [PMID: 27118748 DOI: 10.1136/bcr-2016-214780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We discuss a case of acute kidney injury (AKI) at a very young age caused by primary lymphomatous renal infiltration due to Burkitt's lymphoma and analyse the literature on this rare condition. At presentation, clinical examination showed impressive bilateral nephromegaly and hypertension. Blood analysis indicated severe AKI, mild anaemia and normal serum electrolytes. There were no signs of tumour lysis syndrome. Urine sediment was normal, with neither haematuria nor proteinuria. Abdominal ultrasound demonstrated bilateral renal enlargement (+12 SD), with increased corticomedullar differentiation. MRI demonstrated the presence of a homogenous renal enlargement with features of an infiltrative lesion. Ultimately, microscopic and immunohistochemical analysis of the renal biopsy confirmed the diagnosis of Burkitt's lymphoma. Early and aggressive therapy is the key to ensure a good outcome.
Collapse
Affiliation(s)
- Eva ter Haar
- Department of Pediatric Hemato-oncology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Pediatric Hemato-oncology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Thomas Tousseyn
- Department of Pathology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Pediatric Nephrology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| |
Collapse
|
36
|
Mitome T, Furuya K, Imano M, Osaka K, Yokomizo Y, Hayashi N, Nakaigawa N, Yamanaka S, Yao M. Bilateral renal lymphoma: rapid recovery from an acute kidney injury after open renal biopsy. Clin Case Rep 2016; 4:5-8. [PMID: 26783426 PMCID: PMC4706393 DOI: 10.1002/ccr3.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/13/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022] Open
Abstract
Renal lymphoma as an initial lesion is relatively rare. Bilateral renal lymphoma frequently presents as acute kidney injury. With systematic chemotherapy for the lymphoma, patients usually recover their kidney function. However, in the case we describe here, the patient's kidney function recovered greatly after an open renal biopsy. Here, we review and discuss this unique case.
Collapse
Affiliation(s)
- Taku Mitome
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Kazuhiro Furuya
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Masashi Imano
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Kimito Osaka
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Yumiko Yokomizo
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Narihiko Hayashi
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Noboru Nakaigawa
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Shoji Yamanaka
- Department of Pathology Yokohama City University Hospital Yokohama Kanagawa Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| |
Collapse
|
37
|
Kaneyuki D, Komeno Y, Yoshimoto H, Yoshimura N, Iihara K, Ryu T. Intestinal Intravascular Large B-cell Lymphoma Mimicking Ulcerative Colitis with Secondary Membranoproliferative Glomerulonephritis. Intern Med 2016; 55:2475-81. [PMID: 27580553 DOI: 10.2169/internalmedicine.55.6737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 47-year-old woman with ulcerative colitis (UC) was admitted to our hospital for renal dysfunction and progressive anemia. Colonoscopy revealed intestinal lesions and pathological findings showed intravascular large B-cell lymphoma (IVLBCL). According to the polymerase chain reaction analysis of sequential rectal specimens, we concluded that she suffered from intestinal BCL, not UC. After chemotherapy, her renal function progressed to nephrotic syndrome. The pathological findings of renal biopsy specimens indicated membranoproliferative glomerulonephritis (MPGN). Chemotherapy was continued and led to the remission of BCL and MPGN. We herein describe the first case of intestinal IVLBCL mimicking UC with secondary MPGN.
Collapse
Affiliation(s)
- Daisuke Kaneyuki
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Japan
| | | | | | | | | | | |
Collapse
|
38
|
Tan YZ, Yılmaz S, Özhan M, Halaç M. FDG PET-CT Finding in Bilateral Renal and Bone Involvement of Diffuse Large B-Cell Lymphoma. Mol Imaging Radionucl Ther 2015; 23:104-6. [PMID: 25541935 PMCID: PMC4288226 DOI: 10.4274/mirt.98608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Thirty-six year old male patient with pathological fracture of the left tibia underwent intramedullary and soft tissue curettage. The histopathological examination revealed diffuse large B cell lymphoma. The patient underwent F18-FDG PET-CT scanning for initial staging. FDG PET-CT scan revealed hypermetabolic lesions at the left tibia and in bilateral kidneys. After the systemic chemotherapy and local radiotherapy to the tibia, repeated FDG PET/CT scan showed improvement of the previous hypermetabolic lesions, suggesting good response to therapy. Bone and renal involvement is an uncommon variant of diffuse large B-cell lymphoma and FDG PET-CT is an useful whole body imaging modality in these cases.
Collapse
Affiliation(s)
- Yusuf Ziya Tan
- Çanakkale Onsekiz Mart University, Department of Nuclear Medicine, Çanakkale, Turkey. E-ma-il:
| | | | | | | |
Collapse
|
39
|
Vankalakunti M, Rohan A, Vishwanath S, Rampure S, Bonu R, Babu K, Ballal HS. Spectrum of renal involvement in hematolymphoid neoplasms: Renal biopsy findings of 12 cases. Indian J Nephrol 2015. [PMID: 26199470 PMCID: PMC4495473 DOI: 10.4103/0971-4065.139093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Spectrum of causes for renal dysfunction in patients with hematolymphoid malignancy (excluding plasma cell dyscrasia) is varied. A retrospective evaluation of “native” renal biopsies referred to our institute during the period from January 2010 to December 2013 revealed 12 cases. Age ranged between 7 and 69 (median 54.5) years. All patients were males. The neoplasms included non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, Burkitt's lymphoma, intravascular lymphoma, Hodgkin lymphoma and chronic myeloid leukemia. Proteinuria was noted in 66% of the patients (nephrotic range in 5, subnephrotic range in 3). Renal insufficiency was noted in 100% patients. Malignancy-related kidney injury was noted in 75% of the cases. Renal histology showed lymphomatous infiltration (8), membranoproliferative glomerulonephritis (MPGN) (3), intracapillary monoclonal deposit disease (1) and intravascular lymphoma (1). Distribution of lymphomatous infiltration was diffuse in 50% and focal in 50%. We observed that renal dysfunction was predominantly a direct effect, that is, lymphomatous invasion. Paraneoplastic glomerulopathic changes occur in the form of MPGN. Proteinuria of >2 g/day correlated with glomerular disease.
Collapse
Affiliation(s)
- M Vankalakunti
- Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India
| | - A Rohan
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - S Vishwanath
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - S Rampure
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - R Bonu
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - K Babu
- Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India
| | - H S Ballal
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
40
|
Hasegawa J, Hoshino J, Suwabe T, Hayami N, Sumida K, Mise K, Ueno T, Sawa N, Wake A, Ohashi K, Fujii T, Honda K, Takaichi K, Ubara Y. Characteristics of Intravascular Large B-Cell Lymphoma Limited to the Glomerular Capillaries: A Case Report. Case Rep Nephrol Dial 2015; 5:173-9. [PMID: 26351627 PMCID: PMC4555212 DOI: 10.1159/000437296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 65-year-old woman was admitted to our hospital for the evaluation of rapidly progressive renal dysfunction with serum creatinine of 2.7 mg/dl and urinary protein of 1.5 g daily. C-reactive protein (CRP) was 0.1 mg/dl. Kidney-limited intravascular large B-cell lymphoma (IVL) localized to the glomerular capillaries was diagnosed because the intraglomerular cells were positive for CD20 and CD79a, while there was no positivity in the extraglomerular kidney and extrarenal organs. Treatment with rituximab, cyclophosphamide, hydroxydaunomycin, vincristine, and prednisolone was started, and the patient has since been doing well. When IVL is limited to the intraglomerular capillaries, CRP may not be elevated.
Collapse
Affiliation(s)
- Jumpei Hasegawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Nephrology, Ohkubo Hospital, Tokyo, Japan
| | | | | | | | | | - Koki Mise
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kazuho Honda
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| |
Collapse
|
41
|
Chauvet S, Bridoux F, Ecotière L, Javaugue V, Sirac C, Arnulf B, Thierry A, Quellard N, Milin S, Bender S, Goujon JM, Jaccard A, Fermand JP, Touchard G. Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients. Am J Kidney Dis 2015; 66:756-67. [PMID: 25987261 DOI: 10.1053/j.ajkd.2015.03.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Kidney diseases associated with immunoglobulin M (IgM) monoclonal gammopathy are poorly described, with few data for patient outcomes and renal response. STUDY DESIGN Case series. SETTING & PARTICIPANTS 35 patients from 8 French departments of nephrology were retrospectively studied. Inclusion criteria were: (1) detectable serum monoclonal IgM, (2) estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m(2) and/or proteinuria with protein excretion > 0.5g/d and/or microscopic hematuria, and (3) kidney biopsy showing monoclonal immunoglobulin deposits and/or lymphomatous B-cell renal infiltration. All patients received chemotherapy, including rituximab-based regimens in 8 cases. PREDICTORS Patients were classified into 3 groups according to renal pathology: glomerular AL amyloidosis (group 1; n=11), nonamyloid glomerulopathies (group 2; n=15, including 9 patients with membranoproliferative glomerulonephritis), and tubulointerstitial nephropathies (group 3; n=9, including cast nephropathy in 5, light-chain Fanconi syndrome in 3, and isolated tumor infiltration in 1). OUTCOMES Posttreatment hematologic response (≥50% reduction in serum monoclonal IgM and/or free light chain level) and renal response (≥50% reduction in 24-hour proteinuria or eGFR≥30mL/min/1.73m(2) in patients with glomerular and tubulointerstitial disorders, respectively). RESULTS Nephrotic syndrome was observed in 11 and 6 patients in groups 1 and 2, respectively. Patients in group 3 presented with acute kidney injury (n=7) and/or proximal tubular dysfunction (n=3). Waldenström macroglobulinemia was present in 26 patients (8, 12, and 6 in groups 1, 2, and 3, respectively). Significant lymphomatous interstitial infiltration was observed in 18 patients (4, 9, and 5 patients, respectively). Only 9 of 29 evaluable patients had systemic signs of symptomatic hematologic disease (2, 5, and 2, respectively). In groups 1, 2, and 3, respectively, hematologic response was achieved after first-line treatment in 3 of 9, 9 of 10, and 5 of 6 evaluable patients, while renal response occurred in 5 of 10, 9 of 15, and 5 of 8 evaluable patients. LIMITATIONS Retrospective study; insufficient population to establish the impact of chemotherapy. CONCLUSIONS IgM monoclonal gammopathy is associated with a wide spectrum of renal manifestations, with an under-recognized frequency of tubulointerstitial disorders.
Collapse
Affiliation(s)
- Sophie Chauvet
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Frank Bridoux
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France.
| | - Laure Ecotière
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Vincent Javaugue
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Christophe Sirac
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France
| | - Bertrand Arnulf
- Department of Immunology and Hematology, Hôpital Saint-Louis AP-HP, Paris, France
| | - Antoine Thierry
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Nathalie Quellard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Serge Milin
- Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Sébastien Bender
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France
| | - Jean-Michel Goujon
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France; Department of Hematology, CHU Limoges, Université de Limoges, Limoges, France
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint-Louis AP-HP, Paris, France
| | - Guy Touchard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| |
Collapse
|
42
|
Kitai Y, Matsubara T, Yanagita M. Onco-nephrology: current concepts and future perspectives. Jpn J Clin Oncol 2015; 45:617-28. [DOI: 10.1093/jjco/hyv035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/17/2015] [Indexed: 12/18/2022] Open
|
43
|
White W, Blunden M, McAdoo SP, Sheaff M, Hallam S, McCafferty K. Immunodeficiency-associated renal Burkitt lymphoma. Br J Haematol 2014; 168:769. [PMID: 25441761 DOI: 10.1111/bjh.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- William White
- Departments of Renal Medicine & Transplantation, London, UK.
| | | | | | | | | | | |
Collapse
|
44
|
Kofman T, Zhang SY, Copie-Bergman C, Moktefi A, Raimbourg Q, Francois H, Karras A, Plaisier E, Painchart B, Favre G, Bertrand D, Gyan E, Souid M, Roos-Weil D, Desvaux D, Grimbert P, Haioun C, Lang P, Sahali D, Audard V. Minimal change nephrotic syndrome associated with non-Hodgkin lymphoid disorders: a retrospective study of 18 cases. Medicine (Baltimore) 2014; 93:350-358. [PMID: 25500704 PMCID: PMC4602440 DOI: 10.1097/md.0000000000000206] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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.
Collapse
Affiliation(s)
- Tomek Kofman
- Service de Néphrologie et Transplantation, Groupe hospitalier Henri-Mondor/Albert-Chenevier, Centre de référence maladie rare Syndrome Néphrotique Idiopathique, Institut Francilien de recherche en Néphrologie et Transplantation (IFRNT), AP-HP (Assistance Publique-Hôpitaux de Paris, Créteil), Université Paris Est Créteil, Créteil (TK, DD, PG, PL, DS, VA); Equipe 21, INSERM Unité 955, Université Paris Est Créteil, Créteil (TK, SYZ, AM, DD, PG, PL, DS, VA); Département de Pathologie, Groupe hospitalier Henri-Mondor/Albert-Chenevier, AP-HP, Université Paris Est Créteil, Créteil (CCB, AM); Equipe 9, INSERM Unité 955, Université Paris Est Créteil, Créteil (CCB, CH); Service de Néphrologie, Hôpital Bichat, AP-HP, Université Paris Diderot, Paris (QR); Service de Néphrologie, Hôpital Kremlin Bicêtre, IFRNT, AP-HP, INSERM Unité 1014, Université Paris Sud, Kremlin Bicêtre (HF); Service de Néphrologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris (AK); Service de Néphrologie et Dialyse, Hôpital Tenon, AP-HP, INSERM Unité 702, Université Pierre et Marie Curie-Paris 6, Paris (EP); Service de Néphrologie et Hémodialyse, Centre Hospitalier de Cambrai (BP); Service de Néphrologie, Hopital Pasteur, Université Nice Sophia Antipolis, Nice (GF); Service de Néphrologie et Transplantation, Hôpital Charles Nicolle, Université de Rouen, Rouen (DB); Service d'Hématologie et Thérapie cellulaire, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, Université de Tours François Rabelais, Tours (EG); Service de Néphrologie, Centre Hospitalier intercommunal de Poissy Saint Germain en Laye (MS); Service d'Hématologie clinique, Hôpital La Pitié Salpêtrière, AP-HP, Université Pierre et Marie Curie Paris 06, GRC 11 (GRECHY), Paris (DRW); and Unité d'Hémopathies Lymphoïdes, AP-HP, Groupe hospitalier Henri-Mondor/Albert-Chenevier, Université Paris Est Créteil, Créteil (CH), France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Akpinar TS, Ozkok A, Batu D, Sarihan I, Kose M, Tascioglu C. Isolated renal intravascular lymphoma: a case report and review of the literature. Ren Fail 2014; 36:1125-8. [PMID: 24826874 DOI: 10.3109/0886022x.2014.918829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a very rare subtype of extranodal large B-cell lymphoma. It may involve various organ systems such as skin, liver, lung or kidney. Isolated kidney involvement of IVLBCL is also very rare. Herein we report a very rare case of isolated renal IVLBCL presented with fever of unknown origin, acute kidney injury and nephrotic syndrome. Diagnosis was suspected with isolated high renal (18)F fluorodeoxyglucose uptake in positron emission tomography and confirmed with renal biopsy. Complete remission was obtained with combined chemotherapy including rituximab. We reviewed the English literature in terms of IVLBCL with renal involvement and we could only find 16 such cases. Accordingly, fever, AKI and nephritic syndrome are the most common presenting symptoms in renal intravascular lymphoma.
Collapse
Affiliation(s)
- Timur Selcuk Akpinar
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey , and
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE This article reviews the CT and MRI patterns of primary and secondary renal lymphomas and discusses the role of percutaneous biopsy in diagnosis and management. CONCLUSION Renal lymphoma has a variable imaging spectrum and may mimic renal cell carcinoma. An awareness of the typical and atypical imaging features of both primary and secondary renal lymphomas can help the radiologist to suggest these diagnoses and recommend biopsy when appropriate.
Collapse
|
47
|
Campbell GA, Hu D, Okusa MD. Acute kidney injury in the cancer patient. Adv Chronic Kidney Dis 2014; 21:64-71. [PMID: 24359988 DOI: 10.1053/j.ackd.2013.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 02/08/2023]
Abstract
Acute kidney injury (AKI) is a frequent and significant complication of cancer and cancer therapy. Cancer patients frequently encounter risk factors for AKI including older age, CKD, prerenal conditions, sepsis, exposure to nephrotoxins, and obstructive physiology. AKI can also be secondary to paraneoplastic conditions, including glomerulonephritis and microangiopathic processes. This complication can have significant consequences, including effects on patients' ability to continue to receive therapy for their malignancy. This review will serve to summarize potential etiologies of AKI that present in patients with cancer as well as to highlight specific patient populations, such as the critically ill cancer patient.
Collapse
|
48
|
Luciano RL, Brewster UC. Kidney involvement in leukemia and lymphoma. Adv Chronic Kidney Dis 2014; 21:27-35. [PMID: 24359984 DOI: 10.1053/j.ackd.2013.07.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 11/11/2022]
Abstract
Leukemia and lymphoma are hematologic malignancies that can affect any age group. Disease can be aggressive or indolent, often with multiorgan system involvement. Kidney involvement in leukemia and lymphoma can be quite extensive. Acute kidney injury (AKI) is quite prevalent in these patients, with prerenal and acute tubular necrosis being the most common etiologies. However other prerenal, intrinsic, and obstructive etiologies are possible. AKI can be a direct effect of the malignancy, a complication of the malignancy, or the consequence or side effect of chemotherapy. Nephrotic syndrome and glomerulonephritis, often presenting without overt kidney failure, have also been seen in all forms of leukemia and lymphoma. Lastly, the direct effects of the malignancy and complications from the tumor often result in numerous electrolyte disturbances and acid-base disorders, with life-threatening consequences if left untreated.
Collapse
|
49
|
On W, Udberg M. Acute kidney injury as first presentation of lymphoma: the role of renal biopsy. BMJ Case Rep 2013; 2013:bcr-2013-202196. [PMID: 24293542 DOI: 10.1136/bcr-2013-202196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 65-year-old man with an insidious history of being generally unwell with weight loss, a poor appetite and night sweats was transferred to a tertiary nephrology unit after being found to be in acute kidney injury (AKI). A renal biopsy was performed on the same day which revealed lymphomatous infiltration of the renal parenchyma. He required temporary haemodialysis as he was oliguric and was started on chemotherapy. His renal function improved to baseline 3 weeks after treatment. This case illustrates the uncommon presentation of direct lymphomatous infiltration as a cause of AKI and the integral role of renal biopsy in ascertaining the diagnosis.
Collapse
Affiliation(s)
- Wei On
- Department of Medicine, Countess of Chester NHS Foundation Trust, Chester, UK
| | | |
Collapse
|
50
|
Hughes DJ, Fitzgerald N, Sran H, Konig M, Moore-Moffatt R, Webb A, Gilleece Y, Churchill DR. Acute kidney injury as a presentation of primary renal diffuse large B-cell lymphoma in HIV. Int J STD AIDS 2013; 25:380-2. [PMID: 24047882 DOI: 10.1177/0956462413505084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of acute kidney injury due to primary renal diffuse large B-cell lymphoma, which developed after initiation of tenofovir-containing antiretroviral therapy in a 28-year-old HIV-positive man.
Collapse
Affiliation(s)
- D J Hughes
- Lawson Unit, Royal Sussex County Hospital, Eastern Road, Brighton, UK
| | | | | | | | | | | | | | | |
Collapse
|