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Saito A, Kameoka Y, Ubukawa K, Ohtani H, Abe F, Saito M, Hashimoto M, Kanazawa T, Komatsuda A, Takahashi N. Successful Treatment of Monoclonal Immunotactoid Glomerulopathy Associated with Chronic Lymphocytic Leukemia Using Ibrutinib. Intern Med 2024:3902-24. [PMID: 39370258 DOI: 10.2169/internalmedicine.3902-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2024] Open
Abstract
A 71-year-old woman developed nephrotic syndrome during 10-year follow-up for chronic lymphocytic leukemia. A renal biopsy sample analysis revealed IgG1-lambda-positive monoclonal immunotactoid glomerulopathy (mITG). The patient was treated with ibrutinib, a Bruton tyrosine kinase inhibitor, and complete renal remission was achieved after 24 months. ITG is a rare disease that is characterized by glomerular deposition. In particular, mITG, which presents immune deposits that exhibit light-chain restriction, is often associated with hematologic disorders. Most patients with mITG receive immunosuppressive therapy and/or chemotherapy; however, to our knowledge, there have been no reports of treatment with ibrutinib.
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Affiliation(s)
- Ayano Saito
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Yoshihiro Kameoka
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Kumi Ubukawa
- Department of Internal Medicine, Yuri-Kumiai General Hospital, Japan
| | - Hiroshi Ohtani
- Department of Nephrology, Akita Kousei Medical Center, Japan
| | - Fumito Abe
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Masaya Saito
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Mako Hashimoto
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Tatsuro Kanazawa
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | | | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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Chen A, Turcotte AÈ, Higgins S, Pavic M, Ethier V, Lévesque Dion V. Unusual Cases of Monoclonal Gammopathy of Renal Significance. Case Rep Nephrol 2024; 2024:5556426. [PMID: 39301111 PMCID: PMC11412746 DOI: 10.1155/2024/5556426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 09/22/2024] Open
Abstract
Introduction Monoclonal gammopathy of renal significance (MGRS) is a rare entity describing patients with renal impairment related to the secretion of immunoglobulins without hematological criteria for treatment of a specific disease. We present 3 cases of MGRS identified at our center that were either rare or difficult to diagnose. Case Presentations. The first patient presented with monoclonal membranoproliferative glomerulonephritis in the context of known chronic lymphocytic leukemia (CLL), diagnosed about 10 years prior. She presented with nephritic syndrome with serum protein electrophoresis revealing an IgG/lambda peak of less than 1 g/L, stable from the last few years. A renal biopsy confirmed a diagnosis of monoclonal membranoproliferative glomerulonephritis with granular IgG and C3 deposits of various sizes. The second patient presented with renal TMA in the context of IgM MGUS. The patient was admitted for acute nephritic syndrome and thrombotic microangiopathy. Serum protein electrophoresis demonstrated IgM/kappa paraprotein at 1.8 g/L, with a kappa/lambda ratio of 5.48. Renal biopsy demonstrated endocapillary proliferative glomerulonephritis associated with the presence of numerous monotypic IgM/kappa intracapillary pseudothrombi. Characteristic changes of thrombotic microangiopathy were also described. The third patient presented with immunotactoid glomerulonephritis likely from small B-cell lymphoma that later transformed to DLBCL. The patient presented with acute renal failure with IgM/kappa paraprotein of less than 1 g/L on electrophoresis and with a kappa/lambda ratio of 7.09. A diagnosis of immunotactoid glomerulonephritis was made on renal biopsy. Bone marrow with limited specimen revealed a B-cell infiltrate. Biopsy of a breast lesion was compatible with diffuse large B-cell lymphoma (DLBCL). Lymphomatous cells expressed IgM/kappa, thus confirming paraprotein-associated renal lesion. Conclusion We described 3 different cases of MGRS, highlighting the diversity of renal pathohistological presentations and different associated lymphoproliferative disorders. Biopsy should rapidly be considered, as early diagnosis of MGRS is essential to initiate clone-directed therapy promptly to prevent progression to ESRD or hematologic progression to malignancy.
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Affiliation(s)
- Anjellica Chen
- Department of Internal Medicine Université de Sherbrooke, Sherbrooke, Canada
| | - Anna-Ève Turcotte
- Department of Nephrology Centre Hospitalier Universitaire de Sherbrooke Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Higgins
- Department of Nephrology Centre Hospitalier Universitaire de Sherbrooke Université de Sherbrooke, Sherbrooke, Canada
| | - Michel Pavic
- Department of Hematology Centre Hospitalier Universitaire de Sherbrooke Université de Sherbrooke, Sherbrooke, Canada
| | - Vincent Ethier
- Department of Hematology Centre Hospitalier Universitaire de Sherbrooke Université de Sherbrooke, Sherbrooke, Canada
| | - Vincent Lévesque Dion
- Department of Pathology CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
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Robak T, Puła A, Braun M, Robak E. Extramedullary and extranodal manifestations in chronic lymphocytic leukemia - an update. Ann Hematol 2024; 103:3369-3383. [PMID: 39052034 PMCID: PMC11358350 DOI: 10.1007/s00277-024-05854-1] [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: 03/26/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024]
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a common leukemia characterized by clonal expansion of mature CD5+/CD23 + B cells in the blood, bone marrow (BM) and lymphoid tissues. CLL can undergo extramedullary and extranodal infiltration, with one study noting an incidence of only 0.3 per 100,000 people, and in 17.6% of CLL patients in another report. The most common extranodal sites of leukemic involvement are the skin and central nervous system; however, other organs, including liver, lungs, kidney, gastrointestinal tract, bone, prostate and heart, are occasionally involved. The prognostic significance of extra-medullary CLL is still under debate, but the prognosis in such patients seems to be better in the era of novel targeted drugs. Following a diagnosis of extranodal CLL, survival appears to depend on the site of infiltration. This review presents an overview of CLL in patients with extramedullary and extranodal leukemic lesions, focusing on its epidemiology, pathogenesis, prognosis, clinical characteristics and treatment results.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Ciołkowskiego 2, Lodz, 93-510, Poland.
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland.
| | - Anna Puła
- Department of Hematology, Medical University of Lodz, Ciołkowskiego 2, Lodz, 93-510, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Ewa Robak
- Department of Dermatology, Medical University of Lodz, Lodz, Poland
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Zimmerman MKA, Wilde L. Oh node: Extranodal nodular involvement of chronic lymphocytic leukemia in the colon. Am J Hematol 2024. [PMID: 39194301 DOI: 10.1002/ajh.27467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/29/2024]
Affiliation(s)
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Nasr K, Karam S, Mazepa M, Czyzyk J, Klomjit N. Case report: Successful treatment of renal-limited thrombotic microangiopathy secondary to chronic lymphocytic leukemia. FRONTIERS IN NEPHROLOGY 2024; 4:1400027. [PMID: 39193218 PMCID: PMC11347436 DOI: 10.3389/fneph.2024.1400027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024]
Abstract
Thrombotic microangiopathy (TMA) is a rare renal complication of patients with chronic lymphocytic leukemia (CLL) and is often associated with peripheral features. We present the first case of CLL patients with renal-limited TMA. A 70-year-old female patient with a history of well-controlled type 2 diabetes and baseline albuminuria of 87.2 mg/g 1 year prior and CLL was on active surveillance only. Her baseline white blood cell (WBC) was 202.6 x 103/µl. She presented with nephrotic syndrome with proteinuria of 10 g/g and a subsequent unremarkable serologic work-up. A kidney biopsy revealed diabetic glomerulosclerosis and chronic TMA. Initially, she was treated conservatively with angiotensin receptor blockade and sodium glucose cotransporter-2 inhibition but progressed with increased proteinuria of 17 g/g. Complement functional panel testing was pursued and showed dysregulation of the classical and alternative complement pathways. We decided to treat CLL which was suspected to be the culprit. At 9 months post-ibrutinib initiation, there was a 90% reduction in the WBC as well as a 94% reduction in proteinuria (17 g/g to 0.97 g/g). This case emphasizes the role of complement dysregulation in the pathogenesis of TMA in CLL patients. Treatment of CLL can restore complement dysregulation and improve renal outcomes.
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Affiliation(s)
- Kristina Nasr
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Sabine Karam
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Marshall Mazepa
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jan Czyzyk
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Nattawat Klomjit
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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Eshwarappa M, Rajashekar, Siddaiah GM, Gurudev KC, Udupa K, Yusuff M. A Prospective Observational Study of Renal Involvement in Hematological Malignancies. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:S103-S111. [PMID: 38995278 DOI: 10.4103/sjkdt.sjkdt_66_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Patients with hematological malignancies (HMs) are at high risk of infections and comorbidities that substantially increase the occurrence of renal failure. Thus, the management of renal dysfunction in patients with HMs is crucial. The current study aimed to determine the incidence of renal involvement in patients with HMs and analyze their clinical profile in the context of renal disorders. A prospective observational study was conducted on 200 patients suffering from various HMs. Renal involvement was determined through blood and urine analyses. The mean age of the patients was 51.84 ± 17.47 years, with the male-to-female ratio being 1.5:1. Multiple myeloma (MM) (30.5%) and non-Hodgkin's lymphoma (NHL) (30.5%) were the most commonly observed types of HM, whereas plasmacytoma (1%) was the least observed. Moreover, 39.5% and 16.5% of patients were diagnosed with moderate and severe anemia, respectively. Mean calcium, creatinine, and blood urea nitrogen levels were 8.97 ± 1.19 mg/dL, 1.41 ± 1.37 mg/dL, and 16.83 ± 14.50 mg/dL, respectively. Mean sodium, potassium, and uric acid levels were 135.49 ± 6.79 mEq/L, 4.157 ± 0.65 mEq/L, and 5.81 ± 2.82 mg/dL, respectively. Twelve percent of the patients (24 out of 200) presented with renal insufficiency and nephrotic syndrome. Ten patients were diagnosed with NHL, 10 patients with MM, two with chronic myeloid leukemia, and two with acute myeloid leukemia. The causes of renal impairment in most cases were patchy interstitial lymphoid infiltrates, cast nephropathy, acute tubular necrosis, and minimal change disease.
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Affiliation(s)
- Mahesh Eshwarappa
- Department of Nephrology, M. S. Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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Al-Adl M, El-Said A, El-Sebaie A, Refaat S, Youssef MM. Association of CYP1A1 T3801C (rs4646903) variant with the susceptibility and progression of B-chronic lymphocytic Leukemia (B-CLL) in the Egyptian population. Gene 2023; 883:147673. [PMID: 37506988 DOI: 10.1016/j.gene.2023.147673] [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: 03/23/2023] [Revised: 06/16/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The frequency of hematological malignancies is increasing universally, and over the last few decades, a significant increase in the incidence of B-chronic lymphocytic leukemia (B-CLL) has been observed. Many studies have revealed the involvement of genetic predisposition along with environmental exposure to genotoxic xenobiotics in the leukemogenesis process of B-CLL. CYP1A1 is a vital member of the cytochromes P450 (CYPs) superfamily, which is involved in pro-carcinogens activation into reactive intermediates during phase I xenobiotic biotransformation. AIM This study aimed to determine the possible role of the CYP1A1*2A (T3801C, rs4646903) single nucleotide polymorphism (SNP) as a risk factor for developing B-CLL, as well as the impact of this SNP on the disease progression and the clinical outcome. PATIENTS AND METHODS The study was conducted on 100 patients newly diagnosed with B-CLL, and 100 healthy individuals with matched ages and sex, served as the control group. CYP1A1 (T3801C) genotyping of all patient and control samples was performed using the PCR-based Restriction Fragment Length Polymorphism (RFLP-PCR) method. In addition, serum levels of both IL-6 and TNF-α were estimated by the ELISA technique. RESULTS Higher frequencies of the heterozygous carrier (TC) and homozygous variant (CC) genotypes of the CYP1A1 (T3801C) variant were observed in B-CLL patients compared to the controls (P < 0.001 for both). The frequencies of the CYP1A1 (T3801C) variant indicated a significant elevated risk of B-CLL under various genetic models, including allelic (OR = 8.8, P < 0.001) and dominant (OR = 9.3, P < 0.001) models. In addition, the median IL-6 level was significantly higher in patients with (TC) and (CC) genotypes than in patients with (TT) genotype (P = 0.001 and P < 0.001, respectively). Also, the median TNF-α level was significantly higher in patients with (TC) and (CC) genotypes than in patients with (TT) genotype (P < 0.001 for both). CONCLUSION Our results showed that the CYP1A1*2A (T3801C, rs4646903) SNP increases the susceptibility to B-CLL incidence and is associated with poor disease progression.
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Affiliation(s)
- Menna Al-Adl
- Division of Biochemistry, Chemistry Department, Faculty of Science, Mansoura University, Mansoura, Egypt.
| | - Afaf El-Said
- Genetics Department, Mansoura Children's Hospital, Mansoura, Egypt
| | - Ahmed El-Sebaie
- Hematology Unit, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif Refaat
- Medical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Magdy M Youssef
- Division of Biochemistry, Chemistry Department, Faculty of Science, Mansoura University, Mansoura, Egypt
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Xia S, Ma JT, Raschi E, Ma R, Zhang BK, Guo L, Noguchi Y, Sarangdhar M, Gong H, Yan M. Tumor Lysis Syndrome with CD20 Monoclonal Antibodies for Chronic Lymphocytic Leukemia: Signals from the FDA Adverse Event Reporting System. Clin Drug Investig 2023; 43:773-783. [PMID: 37755660 DOI: 10.1007/s40261-023-01308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Although tumor lysis syndrome was reported with obinutuzumab and rituximab, the association with CD20 monoclonal antibodies for chronic lymphocytic leukemia is unclear. METHODS A disproportionality analysis was conducted to investigate the link between CD20 monoclonal antibodies and tumor lysis syndrome by accounting for known confounders and comparing with other anticancer drugs, using data from the US Food and Drug Administration Adverse Event Reporting System. Reporting odds ratios and the information component were calculated as disproportionality measures. A stepwise sensitivity analysis was conducted to test the robustness of disproportionality signals. Bradford Hill criteria were adopted to globally assess the potential causal relationship. RESULTS From 2004 to 2022, 197, 368, 41, and 14 tumor lysis syndrome reports were detected for obinutuzumab, rituximab, ofatumumab, and alemtuzumab (CD52 monoclonal antibody), respectively. Disproportionality signals were found for the above four monoclonal antibodies when compared with other anticancer drugs. Sensitivity analyses confirmed robust disproportionality signals for obinutuzumab, rituximab, and ofatumumab. The median onset time was 4.5, 1.5, and 2.5 days for rituximab, obinutuzumab, and ofatumumab, respectively. A potential causal relationship was fulfilled by assessing Bradford Hill criteria. CONCLUSIONS This pharmacovigilance study on the FDA Adverse Event Reporting System detected a plausible association between CD20 monoclonal antibodies (but not CD52) and tumor lysis syndrome by assessing the adapted Bradford Hill criteria. Urgent clarification of drug- and patient-related risk factors is needed through large comparative population-based studies.
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Affiliation(s)
- Shuang Xia
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Jia-Ting Ma
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Rui Ma
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Bi-Kui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Linna Guo
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, 501-1196, Japan
| | - Mayur Sarangdhar
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Hui Gong
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China.
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China.
- Toxicology Counseling Center of Hunan Province, Changsha, China.
| | - Miao Yan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road, Furong District, Changsha, 410011, China.
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, 410011, China.
- Toxicology Counseling Center of Hunan Province, Changsha, China.
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Alshemmari SH, Siddiqui MA, Pandita R, Osman HY, Cherif H, O'Brien S, Marashi M, Al Farsi K. Evidence-Based Management of Chronic Lymphocytic Leukemia: Consensus Statements from the Gulf Region. Acta Haematol 2023; 147:260-279. [PMID: 37751733 DOI: 10.1159/000531675] [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: 09/13/2022] [Accepted: 06/16/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Despite recent advances in diagnosis, prognostication, and treatment options, chronic lymphocytic leukemia (CLL) is still a largely incurable disease. New concepts on diagnosis, staging, treatment, and follow-up on CLL have been incorporated throughout recent years. The lack of regional consensus guidelines has led to varying practices in the management of patients with CLL in the region. This manuscript aims to reach a consensus among expert hematologists regarding the definitions, classifications, and related practices of CLL. The experts developed a set of statements utilizing their personal experience together with the current literature on CLL management. This consensus aims to provide guidance for healthcare professionals involved in the management of CLL and serves as a step in developing regional guidelines. METHODS Eight experts responded to 50 statements regarding the diagnosis, staging, treatment, and prognosis of CLL with three potential answering alternatives ranging between agree, disagree, and abstain. This consensus adopted a modified Delphi consensus methodology. A consensus was reached when at least 75% of the agreement to the answer was reached. This manuscript presents the scientific insights of the participating attendees, panel discussions, and the supporting literature review. RESULTS Of the 50 statements, a consensus was reached on almost all statements. Statements covered CLL-related topics, including diagnostic evaluation, staging, risk assessment, different patient profiles, prognostic evaluation, treatment decisions, therapy sequences, response evaluation, complications, and CLL during the COVID-19 pandemic. CONCLUSION In recent years, CLL management has progressed significantly, with many diagnostic tests and several novel treatments becoming available. This consensus gathers decades of consolidated principles, novel research, and promising prospects for the management of this disease.
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Affiliation(s)
- Salem H Alshemmari
- Department of Medicine, Faculty of Medicine and Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh, Kuwait
| | - Mustaqeem A Siddiqui
- Hematology and Oncology Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Mayo Clinic Division of Hematology, Rochester, Minnesota, USA
| | - Ramesh Pandita
- Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh, Kuwait
| | - Hani Y Osman
- Oncology Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Honar Cherif
- Departmant of Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA
| | - Mahmoud Marashi
- Department of Hematology, Dubai Healthcare Authority, Dubai, United Arab Emirates
| | - Khalil Al Farsi
- Department of Hematology, Sultan Qaboos University Hospital Muscat, Seeb, Oman
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Turcotte AE, Glass WF, Lin JS, Burger JA. Membranous nephropathy in chronic lymphocytic leukemia responsive to ibrutinib: A case report. Leuk Res Rep 2023; 20:100377. [PMID: 37457553 PMCID: PMC10338352 DOI: 10.1016/j.lrr.2023.100377] [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: 12/18/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Membranous nephropathy (MN) is an uncommon renal presentation in patients with chronic lymphocytic leukemia (CLL), and as such, there is no standard therapy for these patients. A few cases of MN in CLL have been described with varying success in MN treatment involving alkylating agents and fludarabine. Here we report the first case of MN in a patient with CLL treated with ibrutinib with complete renal response. This presentation underlines the importance of recognizing rare glomerular diseases that may occur with CLL and offers a new therapeutic avenue to the treatment of CLL-associated MN.
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Affiliation(s)
- Anna-Eve Turcotte
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - William F. Glass
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center McGovern Medical School, Houston, TX, United States of America
- Division of Anatomic Pathology, Department of Pathology, The University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Jamie S. Lin
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Jan A. Burger
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Bonilla M, Gudsoorkar P, Wanchoo R, Herrmann SM, Jhaveri KD. Onconephrology 2022: An Update. KIDNEY360 2023; 4:258-271. [PMID: 36821617 PMCID: PMC10103386 DOI: 10.34067/kid.0001582022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/15/2022] [Indexed: 12/14/2022]
Abstract
Onconephrology is an upcoming and expanding subspecialty that deals with the intersections between hematology/oncology and nephrology. With the paradigm shift in the understanding of cancer immunobiology and mechanisms of oncotherapeutic drug toxicities, it is important for a nephrologist to have a sound understanding of this field. Over the last 5 years, there have been immense developments in our understanding of kidney-related adverse events from various targeted, immuno- and cellular-based therapies. Pathogenic mechanisms of electrolyte imbalance, hypertension (oncohypertension), and AKI from multiple forms of cancer therapies have been explored. Significant research has also been conducted in the field of transplant onconephrology. In this review, we have tried to assimilate the most recent updates in the last 2 years in this ever-growing and fascinating field.
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Affiliation(s)
- Marco Bonilla
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Prakash Gudsoorkar
- Division of Nephrology & Kidney Clinical Advancement, Research & Education (C.A.R.E.) Program, University of Cincinnati, Cincinnati, Ohio
| | - Rimda Wanchoo
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Sandra M. Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Kenar D. Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
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Li A, Ambruso SL, Oto OA, Barry M, Edelstein CL. A case report of pre-eclampsia-like endothelial injury in the kidney of an 85-year-old man treated with ibrutinib. BMC Nephrol 2022; 23:264. [PMID: 35870899 PMCID: PMC9308916 DOI: 10.1186/s12882-022-02873-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/03/2022] [Indexed: 01/29/2023] Open
Abstract
Abstract
Background
Glomerular endotheliosis is the pathognomonic glomerular lesion in pre-eclampsia that has also been described in those taking tyrosine kinase inhibitors for cancer treatment. Ibrutinib is a Bruton’s tyrosine kinase inhibitor used to treat chronic lymphocytic leukemia (CLL). We report the first known case of glomerular endotheliosis on kidney biopsy in a patient on ibrutinib monotherapy.
Case presentation
The patient presented with acute on chronic kidney disease, proteinuria, low C3 and C4 and a high rheumatoid factor titer. A kidney biopsy was performed to confirm a preliminary diagnosis of membranoproliferative glomerulonephritis (MPGN), the most common glomerular disease in patients with CLL. Unexpectedly, the kidney biopsy showed pre-eclampsia-like lesions on light and electron microscopy: occlusion of glomerular peripheral capillary lumens by swollen reactive endothelial cells. Findings of glomerulonephritis were not seen, and there were no specific glomerular immune deposits by immunofluorescence or electron microscopy.
Conclusions
CLL is known to cause glomerular lesions, mainly MPGN. There is increasing evidence that ibrutinib, a major treatment for CLL, can cause kidney disease, but the precise pathology is not characterized. We present a patient with CLL on ibrutinib with signs of glomerular endotheliosis. Based on the absence of CLL-induced kidney pathologies typically seen on the kidney biopsy and the non-selectivity of ibrutinib, we attributed the glomerular endotheliosis to ibrutinib. In pre-eclampsia, increased soluble fms-like tyrosine kinase 1 (sFlt1) levels induce endothelial dysfunction by decreasing vascular endothelial growth factor (VEGF). Ibrutinib has been demonstrated to have non-selective tyrosine kinase inhibition, including inhibition of VEGF receptor (VEGFR) and epidermal growth factor receptor (EGFR). VEGFR and EGFR inhibitors have recently been described in the literature to cause hypertension, proteinuria, and glomerular endotheliosis. Kidney biopsy should be performed in CLL patients on ibrutinib that present with acute kidney injury (AKI) or proteinuria to determine whether the clinical picture is attributable to the disease itself or a complication of the therapy.
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13
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Gordon MJ, Ferrajoli A. Unusual complications in the management of chronic lymphocytic leukemia. Am J Hematol 2022; 97 Suppl 2:S26-S34. [PMID: 35491515 DOI: 10.1002/ajh.26585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a common, indolent disease that typically presents with a proliferation of mature, immunologically dysfunctional CD5+ B-cells which preferentially occupy the bone marrow, peripheral blood and lymphoid organs. Immune dysfunction leads to an increase in autoimmune diseases which occur in approximately 10% of patients with CLL. Autoimmune cytopenias are the most common, but other organs may be affected as well. The treatment of these conditions typically depends on the extent of CLL and severity of symptoms, but generally consists of CLL-directed therapies, immunosuppression or both. CLL may also infiltrate extranodal sites in the body. Symptomatic extranodal CLL or extranodal disease which threatens normal organ function is an indication for initiation of CLL-directed therapy. The following review summarizes autoimmune and extranodal complications that can occur in patients with CLL and our suggested approach to their treatment.
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Affiliation(s)
- Max J Gordon
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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14
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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.
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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
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15
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Venetoclax Induces Cardiotoxicity through Modulation of Oxidative-Stress-Mediated Cardiac Inflammation and Apoptosis via NF-κB and BCL-2 Pathway. Int J Mol Sci 2022; 23:ijms23116260. [PMID: 35682939 PMCID: PMC9181135 DOI: 10.3390/ijms23116260] [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: 04/07/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Cardiovascular damage induced by anticancer therapy has become the main health problem after tumor elimination. Venetoclax (VTX) is a promising novel agent that has been proven to have a high efficacy in multiple hematological diseases, especially acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). Considering its mechanism of action, the possibility that VTX may cause cardiotoxicity cannot be ruled out. Therefore, this study was designed to investigate the toxic effect of VTX on the heart. Male Sprague-Dawley rats were randomly divided into three groups: control, low-dose VTX (50 mg/kg via oral gavage), and high-dose VTX (100 mg/kg via oral gavage). After 21 days, blood and tissue samples were collected for histopathological, biochemical, gene, and protein analyses. We demonstrated that VTX treatment resulted in cardiac damages as evidenced by major changes in histopathology and markedly elevated cardiac enzymes and hypertrophic genes markers. Moreover, we observed a drastic increase in oxidative stress, as well as inflammatory and apoptotic markers, with a remarkable decline in the levels of Bcl-2. To the best of our knowledge, this study is the first to report the cardiotoxic effect of VTX. Further experiments and future studies are strongly needed to comprehensively understand the cardiotoxic effect of VTX.
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16
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Chen KW, Rees DO, Watson D, Owen-Casey M. Unusual cause of light chain cast nephropathy. BMJ Case Rep 2022; 15:e246777. [PMID: 35292542 PMCID: PMC8928313 DOI: 10.1136/bcr-2021-246777] [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] [Accepted: 02/17/2022] [Indexed: 11/03/2022] Open
Abstract
Acute kidney injury due to light chain cast nephropathy is increasingly recognised in patients with haematological malignancies; however, the management and prognosis of this disease remain poorly understood. We describe a case of a 78-year-old woman with known chronic lymphocytic leukaemia (CLL) who presented with fatigue and weight loss. She was found to have acute kidney injury, which rapidly worsened during admission. Kidney biopsy showed light chain cast nephropathy and bone marrow biopsy confirmed B-cell CLL. She was started on ibrutinib, halting further deterioration in her renal function and avoiding renal replacement therapy in the first 8 months.
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Affiliation(s)
- Kai Wen Chen
- Nephrology Department, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - David Owen Rees
- Nephrology Department, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - David Watson
- Haematology Department, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Mared Owen-Casey
- Histopathology Department, Betsi Cadwaladr University Health Board, Rhyl, UK
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17
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Ma T, Wang H, Su T, Wang S. Case Report: Chronic Lymphocytic Leukemia With Recurrent Complement-Mediated Thrombotic Microangiopathy and C3 Glomerulonephritis. Front Med (Lausanne) 2022; 9:813439. [PMID: 35223908 PMCID: PMC8866726 DOI: 10.3389/fmed.2022.813439] [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: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a monoclonal B cell lymphocytosis that produces nephrotoxic monoclonal immunoglobulin (MIg). However, the role of MIg in CLL and how it affects CLL patient survival are still unknown. Here, we report a case of MIg with renal significance (MGRS) associated with CLL. A 59-year-old Chinese woman complaining of abdominal pain, skin purpura, and typical soy-colored urine was admitted to the hospital for investigation. Laboratory tests revealed that she had microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury (AKI), and hypocomplementemia. She also reported cryoglobulinemia, thrombotic microangiopathy (TMA), and AKI 2 years previously. Peripheral blood smears at that time showed 4% schistocytes, a negative Coombs' test, and elevated lactate dehydrogenase (LDH). Based on a diagnosis of complement-mediated TMA, the patient was treated by plasmapheresis and achieved clinical disease remission. However, the serum hypocomplement 4 and cryoglobulinemia persisted. Further investigation showed elevated B lymphocytes and monoclonal serum IgMκ; however, the cryoprecipitate contained monoclonal IgMκ and polyclonal IgG, as well as immunoglobulins κ and λ. After plasmapheresis, her LDH, platelets, and complement 3 (C3) levels returned to normal. Biopsies of the bone marrow and an enlarged subclavicular lymph node revealed CLL/SLL. Renal pathological findings indicated significant arteriolar endothelial cells myxoid edema and glomerular endothelial cells swelling, however no thromboli, cryoglobulin formation and vasculitis were observed. We also found mild mesangial proliferative C3 glomerulonephritis and renal interstitial CLL cells infiltration. Collectively, these clinical and pathological manifestations were attributed to monoclonal IgMκ, which triggered C3 activation. MGRS associated with CLL was finally confirmed. Six cycles of rituximab, cyclophosphamide, verodoxin, and dexamethasone therapy were administered, after which she received ibrutinib. The patient experienced disease remission, and her serum C4 level returned to normal. Cryoglobulin and IgMκ were not detected. This is a special presentation of CLL/SLL with monoclonal IgMκ, which is a type of MGRS. Activation of the complement system by MIg led to TMA with C3 glomerulonephritis. Treatment for TMA and CLL/SLL should be initiated in a timely manner to improve patient prognosis.
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Affiliation(s)
- Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hui Wang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
| | - Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
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18
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Jeyabalan A, Trivedi M. Paraneoplastic Glomerular Diseases. Adv Chronic Kidney Dis 2022; 29:116-126.e1. [PMID: 35817519 DOI: 10.1053/j.ackd.2022.02.009] [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: 06/21/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 11/11/2022]
Abstract
Paraneoplastic glomerular diseases (GNs) are rare manifestations in patients with underlying hematologic and solid organ malignancies and can occur before or after the detection of cancer. In the absence of established algorithms for investigation and reliable tests, they remain difficult to diagnose. Given the heterogeneity and infrequency of cases, the pathogenesis of most paraneoplastic GNs is poorly understood. Most of our recent understanding of paraneoplastic GNs has emerged from the discovery of target antigens in membranous nephropathy such as thrombospondin type-1 domain-containing protein 7A and neural epidermal growth factor-like 1 protein that appear to be promising in differentiating a primary vs paraneoplastic cause of membranous nephropathy. Treatment of paraneoplastic GNs is usually directed at the underlying malignancy. This review will focus on the epidemiology, pathogenesis, and diagnosis of paraneoplastic glomerular processes.
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Affiliation(s)
- Anushya Jeyabalan
- Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - Mayuri Trivedi
- Department of Nephrology, Lokmanya Tilak Municipal General Hospital, Mumbai, India.
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19
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Andeen NK, Abdulameer S, Charu V, Zuckerman JE, Troxell M, Kambham N, Alpers CE, Najafian B, Nicosia RF, Smith KD, Kung VL, Avasare RS, Vallurupalli A, Jefferson JA, Hecox D, Swetnam L, Yamashita M, Lin M, Bissonnette ML, Akilesh S, Hou J. A Diverse Spectrum of Immune Complex- and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma. Kidney Int Rep 2022; 7:568-579. [PMID: 35257069 PMCID: PMC8897291 DOI: 10.1016/j.ekir.2021.12.020] [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: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction There are limited reports on kidney biopsy findings in patients with mantle cell lymphoma (MCL). Methods We initiated a multi-institutional, retrospective review of kidney biopsy findings in patients with active and treated MCL. Results A total of 30 patients with MCL and kidney biopsies were identified, with a median age of 67 (range 48-87) years, 73% of whom were men. A total of 20 patients had active MCL at the time of biopsy, of whom 14 (70%) presented with acute kidney injury (AKI), proteinuria and/or hematuria, and biopsy findings potentially attributable to lymphoma. Of the 14, 11 had immune complex (IC) or complement-mediated (C3) disease including proliferative glomerulonephritis (GN) with monotypic Ig deposits (PGNMID [2]), C3GN, (2), secondary membranous nephropathy (MN [3]), tubular basement membrane (TBM) deposits (2), and modest lupus-like GN (2). Lymphomatous infiltration was present in 8 of the 20 patients, 5 with coincident IC or C3 lesions. A total of 6 patients with available follow-up were treated for MCL, all with clinical remission of GN (2 PGNMID, 2 C3GN, and 2 MN). Conclusion MCL is associated with diverse monoclonal and polyclonal glomerular and extra-glomerular IC and C3 disease. For patients with active MCL and kidney dysfunction requiring biopsy, 70% had findings due or potentially due to lymphoma, including 55% with IC or C3 disease and 40% had lymphomatous kidney infiltration. IC and C3GN in the setting of active MCL was responsive to lymphoma-directed therapy.
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Affiliation(s)
- Nicole K. Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Shahad Abdulameer
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Vivek Charu
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Jonathan E. Zuckerman
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Megan Troxell
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Charles E. Alpers
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Behzad Najafian
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Roberto F. Nicosia
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Kelly D. Smith
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Vanderlene L. Kung
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rupali S. Avasare
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Anusha Vallurupalli
- Center for Hematologic Malignancies, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - J. Ashley Jefferson
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Leah Swetnam
- Nephrology, Kaiser Permanente, Portland, Oregon, USA
| | - Michifumi Yamashita
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mercury Lin
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mei Lin Bissonnette
- Department of Pathology, St Paul’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shreeram Akilesh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Jean Hou
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, California, USA
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20
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Silva F, Tavares J, Peixeiro RP, Oliveira J, Fernandes D, Castro A, Santos S, Coutinho R, Freitas C, Santos J, Pimentel JP, Coutinho J, Cabrita A. C3 glomerulopathy associated to B-cell chronic lymphocytic leukemia. Nefrologia 2022; 42:103-105. [PMID: 36153890 DOI: 10.1016/j.nefroe.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/14/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Filipa Silva
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal.
| | - Joana Tavares
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | | | - João Oliveira
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Diana Fernandes
- Internal Medicine Department, Unidade Local de Saúde do Nordeste, Portugal
| | - Ana Castro
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Sofia Santos
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Rita Coutinho
- Hematology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Cristina Freitas
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Josefina Santos
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | | | - Jorge Coutinho
- Hematology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - António Cabrita
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
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21
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Su YQ, Yu YY, Shen B, Yang F, Nie YX. Management of acute kidney injury in gastrointestinal tumor: An overview. World J Clin Cases 2021; 9:10746-10764. [PMID: 35047588 PMCID: PMC8678862 DOI: 10.12998/wjcc.v9.i35.10746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/08/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tumors remain a global health problem. Acute kidney injury (AKI) is a common complication during the treatment of gastrointestinal tumors. AKI can cause a decrease in the remission rate and an increase in mortality. In this review, we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients. The possible mechanisms of AKI were divided into three groups: pretreatment, intrafraction and post-treatment causes. Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.
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Affiliation(s)
- Yi-Qi Su
- Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, Fujian Province, China
| | - Yi-Yi Yu
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Feng Yang
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Yu-Xin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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22
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Acute kidney injury in cancer patients. Clin Exp Nephrol 2021; 26:103-112. [PMID: 34499266 DOI: 10.1007/s10157-021-02131-7] [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: 04/22/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We want to know the causes of AKI in oncology patients, including disease-related complications and the nephrotoxicity of chemotherapy drugs, in order to provide more useful clinical information. METHODS In this review, an electronic search of the English language literature was performed in the database PubMed, with the results enriched by manual searches and citation mining, factors investigated in the selected articles included acute kidney injury, oncology, chemotherapy, anticancer drug, antitumor drug. RESULTS According to the searched articles, we summarized the causes (including pre-renal, intrinsic renal, and post-renal lesion) of AKI in cancer patients and the corresponding management measures. Among the pre-renal factors we mainly described hypercalcemia, hematopoietic cell transplantation, post-renal factors we mainly described hemorrhagic cystitis, and intrinsic renal factors we mainly described thrombotic microangiopathy, chemotherapeutics, tumor lysis syndrome, cast nephropathy, in which the emphasis was on chemotherapy drug associated AKI and its treatment. CONCLUSIONS AKI is not uncommon in cancer patients, and has diverse causes and negative outcomes. Both nephrologists and oncologists need to be aware of the unique reasons of AKI in this population and its optimal management.
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23
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Wang H, Yu X, Zhang X, Wang S, Zhao M. The pathological features of leukemic cells infiltrating the renal interstitium in chronic lymphocytic leukemia/small lymphocytic lymphoma from a large single Chinese center. Diagn Pathol 2021; 16:59. [PMID: 34218814 PMCID: PMC8254985 DOI: 10.1186/s13000-021-01120-4] [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] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is rare in Asians, and patients with CLL/SLL seldomly undergo kidney biopsy. The histopathological features and clinical relevance of tubulointerstitial injury in CLL/SLL have not been extensively characterized. Hence, we attempted to describe the clinical characteristics, renal pathology and clinical outcome of a well-characterized population of CLL/SLL patients with CLL cell infiltration in the renal interstitium from a large single center in China. Methods Between January 1st, 2010 and September 31st, 2020, 31946renal biopsies were performed at Peking University First Hospital, and 10 CLL/SLL patients with CLL cell infiltration in the renal interstitium were included. Complete clinical data were collected from these 10 patients, and renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy. Results The extent of the infiltrating CLL cells in patients with CLL/SLL varied among different patients and ranged from 10 to 90% of kidney parenchyma. Six (60%) of 10 patients presented with an extent of infiltrating CLL cells ≥50%. Interestingly, we found that three patients (3/10, 30%) expressed monoclonal immunoglobulins in the infiltrating CLL cells, and special cytoplasmic crystalline structures were found in two of the three patients by electron microscopy for the first time. Severe renal insufficiency (Scr ≥200 μmol/L) was associated with ≥50% interstitial infiltration of CLL cells in the renal interstitium. Conclusions The current study confirmed that CLL cells infiltrating the renal interstitium can directly secrete monoclonal immunoglobulins, indicating that the interstitial infiltrating CLL cells possibly cause renal injury directly by secreting monoclonal immunoglobulins in situ. This finding may prove a new clue to elucidate the pathogenetic mechanism of renal injury involved with CLL/SLL. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01120-4.
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Affiliation(s)
- Hui Wang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China
| | - Xiaojuan Yu
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.,Department of Nephrology, Peking University First Hospital, Beijing, 100034, People's Republic of China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.
| | - Minghui Zhao
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.,Department of Nephrology, Peking University First Hospital, Beijing, 100034, People's Republic of China
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24
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Ahmed S, Blanco P, MacDonald DA, Hundemer GL. The Case | Nephrotic syndrome in a patient with chronic lymphocytic leukemia. Kidney Int 2021; 99:777-778. [PMID: 33637210 DOI: 10.1016/j.kint.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Sumaiya Ahmed
- Department of Medicine, The Ottawa Hospital; Ottawa, Ontario, Canada
| | - Paula Blanco
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital; Ottawa, Ontario, Canada
| | - David A MacDonald
- Division of Hematology, Department of Medicine, The Ottawa Hospital; Ottawa, Ontario, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital; Ottawa, Ontario, Canada.
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25
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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.
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Panda T, Aggarwal M, Mallick S, Dass J. Hypercalcaemia, renal failure, anaemia and osteolytic lesions (CRAB) in chronic lymphocytic leukaemia mimicking multiple myeloma. BMJ Case Rep 2021; 14:14/3/e238864. [PMID: 33653837 PMCID: PMC7929879 DOI: 10.1136/bcr-2020-238864] [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: 11/04/2022] Open
Abstract
Classical CRAB features (hypercalcaemia, renal failure, anaemia, osteolytic lesions) have been traditionally defined in patients with plasma cell dyscrasia. But these can be rare and uncommon presentations of other chronic lymphoproliferative disorders (CLPD). The pathophysiological basis of CRAB features in other CLPD need to be explored further for better outcomes and therapeutic interventions. These can present a diagnostic dilemma and requires extensive workup to rule out coexisting malignancy and myeloma. Here, we report an unusual case of B CLPD in a middle-aged male who presented with classical CRAB features along with a brief literature review. After detailed investigations, he was diagnosed as chronic lymphocytic leukaemia, without any second malignancy and responded well to ibrutinib-based therapy.
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Affiliation(s)
- Tribikram Panda
- Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mukul Aggarwal
- Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Jasmita Dass
- Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Silva F, Tavares J, Peixeiro RP, Oliveira J, Fernandes D, Castro A, Santos S, Coutinho R, Freitas C, Santos J, Pimentel JP, Coutinho J, Cabrita A. C3 glomerulopathy associated to B-cell chronic lymphocytic leukemia. Nefrologia 2020; 42:S0211-6995(20)30173-9. [PMID: 33358218 DOI: 10.1016/j.nefro.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Filipa Silva
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal.
| | - Joana Tavares
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | | | - João Oliveira
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Diana Fernandes
- Internal Medicine Department, Unidade Local de Saúde do Nordeste, Portugal
| | - Ana Castro
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Sofia Santos
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Rita Coutinho
- Hematology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Cristina Freitas
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - Josefina Santos
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | | | - Jorge Coutinho
- Hematology Department, Centro Hospitalar e Universitário do Porto, Portugal
| | - António Cabrita
- Nephrology Department, Centro Hospitalar e Universitário do Porto, Portugal
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Kumru Şahin G, Kocabay HE, Kiremitçi S, İlhan O, Keven K. Acute Kidney Injury Due to Leukemic Infiltration in a Patient with Chronic Lymphocytic Leukemia. Turk J Haematol 2020; 38:167-168. [PMID: 33161685 PMCID: PMC8171201 DOI: 10.4274/tjh.galenos.2020.2020.0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Gizem Kumru Şahin
- Ankara University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Hasan Emre Kocabay
- Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Saba Kiremitçi
- Ankara University Faculty of Medicine, Department of Medical Pathology, Ankara, Turkey
| | - Osman İlhan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Kenan Keven
- Ankara University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
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Wang LY, Wang JN, Diao ZL, Guan YM, Liu WH. Acute Kidney Injury in Oncology Patients. J Cancer 2020; 11:4700-4708. [PMID: 32626516 PMCID: PMC7330685 DOI: 10.7150/jca.45382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022] Open
Abstract
With rapid progress in cancer diagnosis and treatment in the last two decades, outcomes in oncological patients have improved significantly. However, the incidence of acute kidney injury (AKI) in this population has also increased significantly. AKI complicates many aspects of patients' care and adversely affects their prognoses; thus, accurately diagnosing the risk factors for AKI ensures appropriate management. AKI may be caused by pre-renal, intrinsic renal, and post-renal reasons, as well as for combined reasons. This review summarizes the potential etiologies of AKI according to the three classifications. For each underlying cause of AKI, the cancer itself and/or cancer treatment may contribute to a patient developing AKI. Therefore, we present disease- and treatment-related factors for each cause category, with special focus on immune checkpoint inhibitors, which are being used increasingly more often. It is important for nephrology services to be knowledgeable to provide the best level of care.
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Affiliation(s)
- Li-Yan Wang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jia-Ni Wang
- National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zong-Li Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yi-Ming Guan
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wen-Hu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Santos MLC, Brito BBD, da Silva FAF, Botelho ACDS, Melo FFD. Nephrotoxicity in cancer treatment: An overview. World J Clin Oncol 2020; 11:190-204. [PMID: 32355641 PMCID: PMC7186234 DOI: 10.5306/wjco.v11.i4.190] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/24/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment. The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites, which occurs by glomerular filtration and tubular secretion. Chemotherapeutic agents, both conventional cytotoxic agents and molecularly targeted agents, can affect any segment of the nephron including its microvasculature, leading to many clinical manifestations such as proteinuria, hypertension, electrolyte disturbances, glomerulopathy, acute and chronic interstitial nephritis, acute kidney injury and at times chronic kidney disease. The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs, such as intravascular volume depletion, the associated use of nonchemotherapeutic nephrotoxic drugs (analgesics, antibiotics, proton pump inhibitors, and bone-targeted therapies), radiographic ionic contrast media or radiation therapy, urinary tract obstruction, and intrinsic renal disease. Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect. Therefore, the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.
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Affiliation(s)
- Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
| | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
| | | | | | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
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31
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Manohar S, Bansal A, Wanchoo R, Sakhiya V, Lucia S, Jhaveri KD. Ibrutinib induced acute tubular injury: A case series and review of the literature. Am J Hematol 2019; 94:E223-E225. [PMID: 31148235 DOI: 10.1002/ajh.25546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Sandhya Manohar
- Division of Nephrology and HypertensionMayo Clinic Rochester Minnesota
| | - Anip Bansal
- Division of NephrologyUniversity of Colorado Denver Colorado
| | - Rimda Wanchoo
- Division of Kidney diseases and HypertensionDonald and Barbara Zucker School of Medicine Great Neck New York
| | - Vipulbhai Sakhiya
- Division of Kidney diseases and HypertensionDonald and Barbara Zucker School of Medicine Great Neck New York
| | - Scott Lucia
- Department of PathologyUniversity of Colorado Denver Colorado
| | - Kenar D. Jhaveri
- Division of Kidney diseases and HypertensionDonald and Barbara Zucker School of Medicine Great Neck New York
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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.
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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
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