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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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2
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Lovato E, Gangemi C, Krampera M, Visco C, Ferrarini I. Case Report: Rapid renal response to venetoclax monotherapy in a CLL patient with secondary membranous glomerulonephritis. Front Oncol 2023; 13:1108994. [PMID: 37152058 PMCID: PMC10160354 DOI: 10.3389/fonc.2023.1108994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Membranous glomerulonephritis (MGN) is a rare extra-hematological autoimmune complication of chronic lymphocytic leukemia (CLL), clinically characterized by nephrotic-range proteinuria and, less frequently, renal failure. Because of the rarity of this condition, there is no standardized treatment. Chlorambucil and fludarabine-based regimens, possibly combined with rituximab, have been historically the most frequent therapeutic approaches, with renal response obtained in about two-third of the patients. However, responses are often transient and partial. Here we describe the first patient with rituximab-refractory, CLL-related MGN successfully treated with the Bcl-2 antagonist venetoclax. Nephrotic syndrome resolved as soon as three months after venetoclax initiation, with no unexpected toxicities. At the last follow-up, 17 months after venetoclax start, renal response persists, with proteinuria below 0.5 g/24 hours. This case suggests that targeted agents, particularly Bcl-2 antagonists, might be suitable options for patients with renal autoimmune disorders arising in the context of CLL.
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Affiliation(s)
- Ester Lovato
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Concetta Gangemi
- Division of Nephrology and Dialysis, University Hospital of Verona, Verona, Italy
| | - Mauro Krampera
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Visco
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Isacco Ferrarini
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Isacco Ferrarini,
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3
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Wung W, Ananthakrishnan S, Jonas BA. Proteinuria, Hypoalbuminemia, and Chronic Lymphocytic Leukemia: An Unusual Trio. J Investig Med High Impact Case Rep 2018; 6:2324709618764207. [PMID: 29568782 PMCID: PMC5858612 DOI: 10.1177/2324709618764207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/09/2018] [Accepted: 02/17/2018] [Indexed: 11/16/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a chronic, progressive lymphoproliferative disorder characterized by a monoclonal population of functionally incompetent lymphocytes. Renal involvement is rare and poorly described. A 57-year-old male with no prior medical history was diagnosed with CLL and followed with a watch and wait approach. He was referred to our institution several months later due to concern for Richter's transformation to diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan showed no evidence of diffuse large B-cell lymphoma; however, the patient was noted to have hypoalbuminemia, nephrotic range proteinuria, an acute left renal vein thrombus, and a right pulmonary embolus. A nephrotic syndrome workup including autoimmunity and infection was unremarkable, and a kidney biopsy was deferred due to concern for renal compromise in the setting of a renal vein thrombus. The patient was treated with 6 cycles of reduced-dose fludarabine, cyclophosphamide, and rituximab for a presumed CLL-associated nephrotic syndrome and anticoagulation for his venous thromboemboli. At 6-month follow-up, the patient achieved complete remission of his CLL with normalization of all cell lines and resolution of his nephrotic range proteinuria. Repeat computed tomography scans showed no evidence of recurrent venous thromboemboli. This case demonstrates a potential role of empiric chemotherapy in cases of CLL-associated nephrotic syndrome given its potentially life-threatening sequelae and response to treatment.
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Affiliation(s)
- William Wung
- University of California, Davis, Sacramento, CA, USA
| | | | - Brian A Jonas
- University of California, Davis, Sacramento, CA, USA
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4
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Soldarini M, Farina L, Genderini A, Bolli N. A rare case of atypical chronic lymphocytic leukaemia presenting as nephrotic syndrome. BMJ Case Rep 2017; 2017:bcr-2016-218850. [PMID: 28710302 DOI: 10.1136/bcr-2016-218850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is characterised by a lymphocytosis of mature-appearing clonal CD5+, CD23+ B lymphocytes. CLL cells arise from the bone marrow and infiltrate lymphoid tissues such as lymph nodes and spleen. Presentation is usually through discovery of lymphocytosis or lymphadenopathy. Unusual presentations, especially paraneoplastic syndromes are rare. Here, we describe a rare case presenting with severe nephrotic syndrome associated with the presence of a monoclonal protein in serum. Workup for suspected plasma cell dyscrasia led instead to the diagnosis of bone marrow infiltration by atypical CLL without lymphocytosis. Renal biopsy showed a glomerulonephritis that turned out to be paraneoplastic as it went into remission after treatment for CLL. Our case shows an unusual presentation of CLL and prompts for increased awareness of lymphoproliferative disorders in the context of seemingly unrelated conditions that may be paraneoplastic in origin.
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Affiliation(s)
- Martina Soldarini
- Dipartimento di Oncologia ed Onco-Ematologia, Universita' degli Studi di Milano, Milano, Italy
| | - Lucia Farina
- Dipartimento di Oncologia medica ed Ematologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Augusto Genderini
- Unità operativa complessa di nefrologia e dialisi, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Milano, Italy
| | - Niccolo Bolli
- Dipartimento di Oncologia ed Onco-Ematologia, Universita' degli Studi di Milano, Milano, Italy
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5
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Strati P, Nasr SH, Leung N, Hanson CA, Chaffee KG, Schwager SM, Achenbach SJ, Call TG, Parikh SA, Ding W, Kay NE, Shanafelt TD. Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience. Haematologica 2015; 100:1180-8. [PMID: 26088927 DOI: 10.3324/haematol.2015.128793] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/10/2015] [Indexed: 11/09/2022] Open
Abstract
While the renal complications of plasma cell dyscrasia have been well-described, most information in patients with chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis is derived from case reports. This is a retrospective analysis of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who underwent kidney biopsy for renal insufficiency and/or nephrotic syndrome. Between January 1995 and June 2014, 49 of 4,024 (1.2%) patients with chronic lymphocytic leukemia (n=44) or monoclonal B-cell lymphocytosis (n=5) had a renal biopsy: 34 (69%) for renal insufficiency and 15 (31%) for nephrotic syndrome. The most common findings on biopsy were: membranoproliferative glomerulonephritis (n=10, 20%), chronic lymphocytic leukemia interstitial infiltration as primary etiology (n=6, 12%), thrombotic microangiopathy (n=6, 12%), and minimal change disease (n=5, 10%). All five membranoproliferative glomerulonephritis patients treated with rituximab, cyclophosphamide and prednisone-based regimens had recovery of renal function compared to 0/3 patients treated with rituximab with or without steroids. Chronic lymphocytic leukemia infiltration as the primary cause of renal abnormalities was typically observed in relapsed/refractory patients (4/6). Thrombotic microangiopathy primarily occurred as a treatment-related toxicity of pentostatin (4/6 cases), and resolved with drug discontinuation. All cases of minimal change disease resolved with immunosuppressive agents only. Renal biopsy plays an important role in the management of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who develop renal failure and/or nephrotic syndrome.
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Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Samih H Nasr
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nelson Leung
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | | | | | | | - Wei Ding
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Neil E Kay
- Mayo Clinic College of Medicine, Rochester, MN, USA
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6
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Asmandar S, Figuères ML, Goujon JM, Noël LH, Hummel A. [Diagnostic value of IgG subtypes in membranous nephropathy: A case report]. Nephrol Ther 2015; 11:169-72. [PMID: 25921735 DOI: 10.1016/j.nephro.2015.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
The study of immunoglobulin G subtypes constituting immune deposits present in membranous nephropathy is useful to guide diagnosis. IgG4 deposits are more often seen in primitive forms of membranous nephropathy due to autoantibody (anti-phospholipase A2 receptor in a majority of cases). These deposits are polytypic. In secondary forms, deposits are constituted of IgG1, IgG2 and IgG3. We report the case of a 52-year-old woman whose renal biopsy, done for glomerular proteinuria, shows membranous nephropathy with monotypic IgG4 deposits with no overt hematologic malignancy and no anti-PLA2R antibodies.
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Affiliation(s)
- Safaa Asmandar
- Laboratoire d'anatomie pathologique, université René-Descartes, hôpital Necker, 75015 Paris, France
| | - Marie-Lucile Figuères
- Laboratoire d'anatomie pathologique, université René-Descartes, hôpital Necker, 75015 Paris, France
| | - Jean-Michel Goujon
- Laboratoire d'anatomie pathologique, université de Poitiers, 86000 Poitiers, France
| | - Laure-Hélène Noël
- Laboratoire d'anatomie pathologique, université René-Descartes, hôpital Necker, 75015 Paris, France
| | - Aurélie Hummel
- Pôle de néphrologie et de transplantation, université René-Descartes, hôpital Necker, 75015 Paris, France.
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7
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Castro JE, Diaz-Perez JA, Barajas-Gamboa JS, Horton JM, Weidner N, Kipps TJ. Chronic lymphocytic leukemia associated with immunotactoid glomerulopathy: a case report of successful treatment with high-dose methylprednisolone in combination with rituximab followed by alemtuzumab. Leuk Lymphoma 2012; 53:1835-8. [PMID: 22335532 DOI: 10.3109/10428194.2012.663914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Dose-Response Relationship, Drug
- Humans
- Immunoglobulins/metabolism
- Kidney Diseases/complications
- Kidney Diseases/diagnosis
- Kidney Diseases/drug therapy
- Kidney Glomerulus/drug effects
- Kidney Glomerulus/immunology
- Kidney Glomerulus/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Methylprednisolone/administration & dosage
- Middle Aged
- Rituximab
- Treatment Outcome
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8
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Dou X, Hu H, Ju Y, Liu Y, Kang K, Zhou S, Chen W. Concurrent nephrotic syndrome and acute renal failure caused by chronic lymphocytic leukemia (CLL): a case report and literature review. Diagn Pathol 2011; 6:99. [PMID: 21995711 PMCID: PMC3206418 DOI: 10.1186/1746-1596-6-99] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 10/13/2011] [Indexed: 11/15/2022] Open
Abstract
Kidney injury associated with lymphocytic leukemia (CLL) is typically caused by direct tumor infiltration which occasionally results in acute renal failure. Glomerular involvement presenting as proteinuria or even nephrotic syndrome is exceptionally rare. Here we report a case of 54-year-old male CLL patient with nephrotic syndrome and renal failure. The lymph node biopsy confirmed that the patients had CLL with remarkable immunoglobulin light chain amyloid deposition. The renal biopsy demonstrated the concurrence of AL amyloidosis and neoplastic infiltration. Combined treatment of fludarabine, cyclophosphamide and rituximab resulted in remission of CLL, as well as the renal disfunction and nephrotic syndrome, without recurrence during a 12-month follow-up. To our knowledge, this is the first case of CLL patient showing the nephrotic syndrome and acute renal failure caused by AL amyloidosis and neoplastic infiltration. Though AL amyloidosis caused by plasma cell dyscrasia usually responses poorly to chemotherapy, this patient exhibited a satisfactory clinical outcome due to successful inhibition of the production of amylodogenic light chains by combined chemotherapy.
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Affiliation(s)
- Xianrui Dou
- Department of Nephrology, Affiliated Shunde First People's Hospital of Southern Medical University, Penglai Road, Daliang District, Foshan 528300, China
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9
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van der Bij A, Betjes M, Weening J, Cornelissen J, Mes T, Osterhaus A, Beersma M. BK virus nephropathy in an immunodeficient patient with chronic lymphocytic leukemia. J Clin Virol 2009; 45:341-4. [PMID: 19477682 DOI: 10.1016/j.jcv.2009.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 04/23/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND BK virus, genus polyomavirus, is known as an important cause of nephropathy (BKVN) in renal transplant patients. Cases of BKVN in native kidneys are rare. OBJECTIVES To report a case of BKVN in a patient with chronic lymphocytic leukemia (CLL) and to examine viral and immune parameters. STUDY DESIGN Quantitative BK virus DNA in plasma and relevant immune parameters were recorded in one CLL patient with BKVN and ten consecutive CLL patients without BKVN. RESULTS BKVN in the native kidneys of a CLL patient was histologically confirmed. The presence of BKVN correlated with immunologic parameters as well as factors known to cause renal tissue injury. BK viral load levels in the patient steadily increased and exceeded those of the control CLL patients. CONCLUSIONS The results document a pathogenic role for BK virus in native kidneys of immuno-compromised CLL patients and indicate a role for quantitative BK virus DNA detection for early management of BKVN in native kidneys.
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Affiliation(s)
- Akke van der Bij
- Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Zeng CH, Chen HM, Wang RS, Chen Y, Zhang SH, Liu L, Li LS, Liu ZH. Etiology and clinical characteristics of membranous nephropathy in Chinese patients. Am J Kidney Dis 2008; 52:691-8. [PMID: 18805348 DOI: 10.1053/j.ajkd.2008.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 06/04/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Membranous nephropathy (MN) is a common cause of proteinuria and can be subdivided into idiopathic and secondary classifications. Most patients with MN present with associated systemic diseases that need to be identified before appropriately diagnosing idiopathic MN. However, the cause and clinical characteristics of MN in Chinese patients have not been investigated. STUDY DESIGN Case series. SETTING & PARTICIPANTS Patients with biopsy-proven MN at the Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. OUTCOME The diagnosis of idiopathic and secondary MN was based on clinical, initial laboratory, and histological findings. RESULTS 390 patients with MN were identified from 1985 to 2005. Of 390 patients with MN, 124 (31.8%) had idiopathic MN and 266 had secondary MN (68.2%). Of patients with idiopathic MN, 75 (60.5%) were men and 49 (39.5%) were women. Mean age was 43.9 +/- 13.2 years (range, 14 to 78 years). Common presentations of idiopathic MN were 60.5% with proteinuria (39.5% of whom presented with nephrotic syndrome), 29.8% with hypertension, 17.7% with hematuria, and 0.8% with decreased kidney function. In patients with secondary MN, causes were autoimmune diseases (73.3%), infections (17.7%), tumors (4.5%), and drugs or toxins (4.5%). Systemic lupus erythematosus was the most common autoimmune disease (predominately in younger women). Hepatitis B predominated in younger men. Greater levels of proteinuria were found in patients who presented with drugs or toxins compared with patients with other secondary MNs (P < 0.05). LIMITATIONS Not all patients underwent all tests, particularly serum tumor markers, hepatitis C virus antibody, and hepatitis C virus RNA tests. CONCLUSION Proteinuria was a common presentation in patients with idiopathic MN, which was predominately found in middle-aged to elderly men. Secondary MN was more common than idiopathic MN, and most secondary MN diagnoses were secondary to systemic lupus erythematosus and hepatitis B infection.
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Affiliation(s)
- Cai-Hong Zeng
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
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11
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Bjørneklett R, Vikse BE, Svarstad E, Aasarød K, Bostad L, Langmark F, Iversen BM. Long-term risk of cancer in membranous nephropathy patients. Am J Kidney Dis 2007; 50:396-403. [PMID: 17720518 DOI: 10.1053/j.ajkd.2007.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/13/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a well-known association between membranous nephropathy (MN) and cancer, and patients with MN usually are examined for cancer at the time of diagnosis. The long-term risk of cancer after MN is not well studied. STUDY DESIGN Cohort study with record linkage between the Norwegian Kidney Biopsy Registry and Norwegian Cancer Registry. SETTING & PARTICIPANTS 161 patients with MN from 1988 to 2003. PREDICTOR Patients with MN compared with the age- and sex-adjusted general Norwegian population. OUTCOMES Cancer diagnosis reported through 2003. RESULTS Mean duration of follow-up was 6.2 years (range, 0.1 to 15 years). 33 patients developed cancer; including 24 patients with cancer after the diagnosis of MN. Median time from diagnosis of MN to diagnosis of cancer was 60 months (range, 0 to 157 months). Mean annual incidence ratio of cancer was 2.4/100 person-years (2.1/100 person-years in the 0- to 5-year period and 2.8/100 person-years for the 5 to 15 years after kidney biopsy). During the 0 to 15 years after the diagnosis of MN, the expected number of cancers was 10.7, resulting in a standardized incidence ratio of cancer of 2.25 (95% confidence interval, 1.44 to 3.35). In the 5 to 15 years after diagnosis, standardized incidence ratio was 2.30 (95% confidence interval, 1.19 to 4.02). Patients with MN who developed cancer were older (65 versus 52 years; P < 0.001). Patients with cancer and MN had a greater mortality rate than patients without cancer (67% versus 26%; P < 0.001). LIMITATIONS Follow-up treatment after MN with cytotoxic and immunosuppressive medications is not known. CONCLUSIONS An increased risk of developing cancer is observed after the diagnosis of MN, which persists for many years.
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Affiliation(s)
- Rune Bjørneklett
- The Norwegian Kidney Biopsy Registry, Haukeland University Hospital, Bergen, Norway
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12
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Kiewe P, Tepel M, Loddenkemper C, Grünbaum M, Grabowski P, Korfel A, Thiel E. Extensive leukemic kidney infiltration with membranoproliferative glomerulonephritis in a patient with B-cell chronic lymphocytic leukemia. Ann Hematol 2007; 86:691-2. [PMID: 17447066 DOI: 10.1007/s00277-007-0293-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
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13
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Lefaucheur C, Stengel B, Nochy D, Martel P, Hill GS, Jacquot C, Rossert J. Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association. Kidney Int 2006; 70:1510-7. [PMID: 16941021 DOI: 10.1038/sj.ki.5001790] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The association between membranous nephropathy (MN) and cancer is often mentioned in textbooks but poorly substantiated, and the characteristics of cancer-associated MN are unknown. To address these questions, we studied a cohort of 240 patients with MN, among them 24 had malignancy at the time of renal biopsy or within a year thereafter. The incidence of cancer was significantly higher in these patients than in the general population (standardized incidence ratio 9.8 [5.5-16.2] for men and 12.3 [4.5-26.9] for women). The frequency of malignancy increased with age. At the time of diagnosis, clinical presentation did not differ between the patients with cancer-associated MN and those with idiopathic MN, but smoking was more frequent among patients with cancer. Analysis of renal biopsies revealed that the number of inflammatory cells infiltrating the glomeruli was significantly higher in patients with cancer-associated MN (P = 0.001). The best cutoff value for distinguishing malignancy-related cases from controls was eight cells per glomerulus. Using this threshold led to a diagnosis of cancer-associated MN with a specificity of 75% and a sensitivity of 92%. In patients with cancer-associated MN, there was a strong relationship between reduction of proteinuria and clinical remission of cancer (P < 0.001). In conclusion, our study provides epidemiologic evidence of an excess of cancer risk in patients with MN. It also shows that age, smoking, and the presence of glomerular leukocytic infiltrates strongly increase the likelihood of malignancy in MN patients.
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Affiliation(s)
- C Lefaucheur
- Paris-Descartes University School of Medicine, Paris, France
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14
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Ziakas PD, Giannouli S, Psimenou E, Nakopoulou L, Voulgarelis M. Membranous glomerulonephritis in chronic lymphocytic leukemia. Am J Hematol 2004; 76:271-4. [PMID: 15224365 DOI: 10.1002/ajh.20109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We present a case of chronic lymphocytic leukemia associated with nephrotic syndrome. Renal biopsy revealed membranous glomerulonephritis accompanied by interstitial monoclonal lymphocytic infiltration. Combination therapy with cyclophosphamide, vincristine, and prednisone (COP) was successful in inducing an effective response in chronic lymphocytic leukemia. Improvement of renal function and proteinuria was also observed.
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Affiliation(s)
- Panayiotis D Ziakas
- Department of Pathophysiology, Medical School, National University of Athens, M. Asias 75, Goudi, 11527 Athens, Greece
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15
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Hill PA, Firkin F, Dwyer KM, Lee P, Murphy BF. Membranoproliferative glomerulonephritis in association with chronic lymphocytic leukaemia: a report of three cases. Pathology 2002; 34:138-43. [PMID: 12009095 DOI: 10.1080/003130201201117945] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The reported association of glomerular disease with chronic lymphocytic leukaemia (CLL) is rare despite the relative frequency of this type of leukaemia. Hence, we have examined the renal biopsies in three patients with CLL and glomerulonephritis. METHODS Renal biopsies were examined by light microscopy, immunofluorescence microscopy and electron microscopy. RESULTS One of two patients with mild impairment of renal function and an active urinary sediment had ultrastructural features of idiopathic type I membranoproliferative glomerulonephritis (MPGN), and the other had features of fibrillary/ immunotactoid glomerulonephritis with deposits of IgG and C3. One patient with nephrotic syndrome had characteristic electron microscopic appearances of type III MPGN. In all three there was an association with monoclonal gammopathy. The parameters of glomerular damage improved in association with response to drug treatment of the CLL. CONCLUSION There is a spectrum of types of MPGN seen in patients with CLL and there appears to be an association with the presence of monoclonal gammopathy. This is the first reported case of type III MPGN in CLL.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Chlorambucil/therapeutic use
- Drug Therapy, Combination
- Female
- Glomerular Mesangium/ultrastructure
- Glomerulonephritis, Membranoproliferative/complications
- Glomerulonephritis, Membranoproliferative/drug therapy
- Glomerulonephritis, Membranoproliferative/pathology
- Humans
- Kidney Glomerulus/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Microscopy, Fluorescence
- Middle Aged
- Paraproteinemias/complications
- Paraproteinemias/drug therapy
- Paraproteinemias/pathology
- Prednisolone/therapeutic use
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- Prudence A Hill
- Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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