1
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Bender ST, Zeremski V, Wiech T, Mertens PR, Gross C. Case report: Acute kidney injury as the initial manifestation of chronic lymphocytic leukemia/small lymphocytic lymphoma. Front Med (Lausanne) 2023; 10:1279005. [PMID: 37928472 PMCID: PMC10622965 DOI: 10.3389/fmed.2023.1279005] [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: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder often diagnosed after incidental finding of leukocytosis. Renal involvement is usually clinically silent. Symptomatic renal impairment due to CLL/small lymphocytic lymphoma (SLL) cell infiltration in the kidney tissue is uncommon, and acute kidney injury (AKI) as a presenting feature is rare. In this case report, we describe the case of a patient with AKI caused by CLL/SLL infiltration as a presenting feature. Our report highlights the possibility of kidney injury as the first evident symptom of CLL/SLL. Kidney biopsy is the mainstay in these cases in order to establish a diagnosis. Treatment with zanubrutinib resulted in improved kidney function.
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Affiliation(s)
- Sascha T. Bender
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vanja Zeremski
- University Hospital for Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Thorsten Wiech
- Institute for Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Christian Gross
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
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2
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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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3
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Abramson M, Mehdi A. Hematological Malignancies and the Kidney. Adv Chronic Kidney Dis 2022; 29:127-140.e1. [PMID: 35817520 DOI: 10.1053/j.ackd.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
The incidence of hematologic malignancies is on the rise worldwide. Kidney disease is ubiquitous in patients with hematologic malignancies, encompassing a wide spectrum of disorders involving each kidney compartment, including the vasculature, tubules, interstitium, and glomerulus, and there is significant overlap of kidney involvement with each hematologic malignancy. Vascular disorders include both microvascular and macrovascular damage, via thrombotic microangiopathy, hyperleukocytosis, hyperviscosity, and cryoglobulinemia. The tubulointerstitial compartment may be affected by prerenal azotemia and acute tubular injury, but malignant infiltration, tumor lysis syndrome, extramedullary hematopoiesis, cast nephropathy, granulomatous interstitial nephritis, and lysozymuria should be considered in certain populations. Obstructive uropathy may occur due to nephrolithiasis or retroperitoneal fibrosis. Glomerular disorders, including membranoproliferative, membranous, minimal change, and focal segmental glomerulosclerosis, can rarely occur. By understanding how each compartment may be affected, care can best be optimized for these patients. In this review, we summarize the widely varied etiologies of kidney diseases stratified by kidney compartment and hematologic malignancy, focusing on demographics, pathology, pathophysiology, mechanism, and outcomes. We conclude with common electrolyte abnormalities associated with hematologic malignancies.
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4
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Wanchoo R, Bernabe Ramirez C, Barrientos J, Jhaveri KD. Renal involvement in chronic lymphocytic leukemia. Clin Kidney J 2018; 11:670-680. [PMID: 30288263 PMCID: PMC6165759 DOI: 10.1093/ckj/sfy026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/26/2018] [Indexed: 12/14/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed adult leukemia in the USA and Western Europe. Kidney disease can present in patients with CLL as a manifestation of the disease process such as acute kidney injury with infiltration or with a paraneoplastic glomerular disease or as a manifestation of extra renal obstruction and tumor lysis syndrome. In the current era of novel targeted therapies, kidney disease can also present as a complication of treatment. Tumor lysis syndrome associated with novel agents such as the B-cell lymphoma 2 inhibitor venetoclax and the monoclonal antibody obinutuzumab are important nephrotoxicities associated with these agents. Here we review the various forms of kidney diseases associated with CLL and its therapies.
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Affiliation(s)
- Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Carolina Bernabe Ramirez
- Division of Hematology and Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Jacqueline Barrientos
- Division of Hematology and Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
- CLL Research and Treatment Program, Lake Success, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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5
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Visentin A, Briani C, Imbergamo S, Frezzato F, Angelini A, Fedrigo M, Cacciavillani M, Altinier S, Piazza F, Semenzato G, Adami F, Trentin L. Idelalisib plus rituximab is effective in systemic AL amyloidosis secondary to chronic lymphocytic leukaemia. Hematol Oncol 2017; 36:366-369. [PMID: 28971495 DOI: 10.1002/hon.2480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/11/2022]
Abstract
Light chain amyloidosis is characterized by the progressive deposition of immunoglobulin light chains into the extracellular tissue, leading to organ dysfunction. Usually, it is associated with an underlying clonal plasma cell dyscrasia and rarely with chronic lymphocytic leukaemia. Herein, we described the first report of a patient with relapsed chronic lymphocytic leukaemia harbouring TP53 abnormalities who developed, histologically proven, systemic light chain amyloidosis who was treated with the PI3K inhibitor, idelalisib, and rituximab. Unfortunately, the patient had sudden death during sleep, likely caused by arrhythmia secondary to amyloid cardiomyopathy. Idelalisib was at least effective in reducing secretory free light chain, chronic lymphocytic leukaemia burden, and to improve the survival of patient.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Federica Frezzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Annalisa Angelini
- General Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marny Fedrigo
- General Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Sara Altinier
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Gianpietro Semenzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Fausto Adami
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
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6
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Pre-B acute lymphoblastic leukemia with t(1;19) in an adult initially presenting as hematuria and bilateral renal enlargement: a case report and literature review. Clin Nephrol Case Stud 2017; 5:60-65. [PMID: 29043149 PMCID: PMC5642469 DOI: 10.5414/cncs109113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/02/2017] [Indexed: 11/18/2022] Open
Abstract
Although pre-B acute lymphoblastic leukemia (ALL) is the most common type of renal leukemic infiltration; the renal infiltration with leukemia cells as the initial manifestation of leukemia is very rare. Translocation (1;19)(q23;p13) is one of the most common chromosomal abnormalities in patients with ALL and is observed in 5 - 6% of children with pre-B ALL. However, the incidence of t(1;19) in adults is lower, not exceeding 3%, and the prognosis of adult patients is usually poor. Herein, we report a 52-year-old female patient with pre-B ALL who initially presented as bilateral renal enlargement. The cytogenetic analysis revealed chromosomal abnormalities including t(1;19). The patient underwent three consecutive courses of chemotherapy with VDLP (vincristine, daunorubicin, L-asp, and prednisolone) and gained a short complete remission. Her kidneys recovered to normal size, and renal function returned to normal level. However, after complete remission for only 3 months, the patient exhibited resistance to consolidation chemotherapy and indicated evidence of marrow relapse. Although we increased the drug dosage and attempted to use a different protocol, she died of severe anemia and hemorrhage almost 10 months after she was first admitted. In conclusion, pre-B cell ALL is the most common type of leukemia to present with renal infiltration as the presenting sign. Because of the poor outcome of ALL, some new therapeutic approaches may improve the patients' conditions.
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7
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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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Arora S, Levitan D, Regmi N, Sidhu G, Gupta R, Nicastri AD, Saggi SJ, Braverman A. Cryoglobulinemia in a patient with chronic lymphocytic leukemia - A case report and review of literature of renal involvement in CLL. Blood Cells Mol Dis 2016; 60:7-11. [PMID: 27519936 DOI: 10.1016/j.bcmd.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/21/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
The incidence of glomerulonephritis, as a manifestation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), has always been considered low. Though renal infiltration is usually detected at post-mortem, it does not often interfere with kidney function [1]. Though immunoglobulin (Ig) levels in most CLL patients are subnormal, small monoclonal Ig peaks are occasionally detected in serum. They were present in a number of reported CLL nephropathy patients, and not all were cryoglobulins; serum and glomerular staining were concordant for Ig type [2,3,4]. Myeloma, which secretes monoclonal light chains, causes nephropathy in 25% of patients. But the little presumably secreted by small plasma cell clones, without myeloma, may also be nephrotoxic. The same is true of the low secretory CLL cells, which may occasionally be associated with cryoglobulins and other nephrotoxic Igs [5]. We report a patient with early stage CLL (Rai stage 0) with cryoglobulins, which led to membranoproliferative glomerulonephritis (MPGN), and death. We located reports of 51 patients with CLL-associated nephrotic syndrome or nephropathy, mostly from MPGN related to local Ig deposits. In those patients screened for cryoglobulins, about half tested positive. Many were early stage cases, where MPGN developed long after CLL presentation, and responded to its treatment. As early diagnosis and treatment CLL-related nephropathy may be curative, we propose a prospective study to determine the incidence of hyperalbuminuria development after presentation.
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Affiliation(s)
- Swaty Arora
- Department of Hematology & Oncology, Department of Medicine, State University New York, Downstate, USA.
| | - Daniel Levitan
- Department of Pathology, State University New York, Downstate, USA
| | - Narottam Regmi
- Department of Nephrology, Department of Medicine, State University New York, Downstate, USA
| | - Gurinder Sidhu
- Department of Hematology & Oncology, Department of Medicine, State University New York, Downstate, USA
| | - Raavi Gupta
- Department of Pathology, State University New York, Downstate, USA
| | | | - Subodh J Saggi
- Department of Nephrology, Department of Medicine, State University New York, Downstate, USA
| | - Albert Braverman
- Department of Hematology & Oncology, Department of Medicine, State University New York, Downstate, USA
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9
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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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10
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Poitou-Verkinder AL, Francois A, Drieux F, Lepretre S, Legallicier B, Moulin B, Godin M, Guerrot D. The spectrum of kidney pathology in B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma: a 25-year multicenter experience. PLoS One 2015; 10:e0119156. [PMID: 25811382 PMCID: PMC4374947 DOI: 10.1371/journal.pone.0119156] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/10/2015] [Indexed: 01/22/2023] Open
Abstract
Background Chronic lymphocytic leukemia and small lymphocytic lymphoma are 2 different presentations of the most common B-cell neoplasm in western countries (CLL/SLL). In this disease, kidney involvement is usually silent, and is rarely reported in the literature. This study provides a clinicopathological analysis of all-cause kidney disease in CLL/SLL patients. Methods Fifteen CLL/SLL patients with kidney biopsy were identified retrospectively. Demographic, clinical, pathological and laboratory data were assessed at biopsy, and during follow-up. Results At biopsy 11 patients presented impaired renal function, 7 patients nephrotic syndrome, 6 patients dysproteinemia, and 3 patients cryoglobulinemia. Kidney pathology revealed CLL/SLL-specific monoclonal infiltrate in 10 biopsies, glomerulopathy in 9 biopsies (5 membranoproliferative glomerulonephritis, 2 minimal change disease, 1 glomerulonephritis with organized microtubular monoclonal immunoglobulin deposits, 1 AHL amyloidosis). Five patients presented interstitial granulomas attributed to CLL/SLL. After treatment of the hematological disease, improvement of renal function was observed in 7/11 patients, and remission of nephrotic syndrome in 5/7 patients. During follow-up, aggravation of the kidney disease systematically occurred in the absence of favorable response to hematological treatment. Conclusions A broad spectrum of kidney diseases is associated with CLL/SLL. In this setting, kidney biopsy can provide important information for diagnosis and therapeutic guidance.
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Affiliation(s)
| | - Arnaud Francois
- Service d’Anatomie Pathologique, CHU Hôpitaux de Rouen, Rouen, France
| | - Fanny Drieux
- Service d’Anatomie Pathologique, CHU Hôpitaux de Rouen, Rouen, France
| | | | | | - Bruno Moulin
- Service de Néphrologie, CHU Hôpitaux de Strasbourg, Strasbourg, France
| | - Michel Godin
- Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France
- INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France
| | - Dominique Guerrot
- Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France
- INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France
- * E-mail:
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11
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Ding S, Xu Y, Hao T, Ma P. Partial least squares based gene expression analysis in renal failure. Diagn Pathol 2014; 9:137. [PMID: 24997640 PMCID: PMC4104724 DOI: 10.1186/1746-1596-9-137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/25/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Preventive and therapeutic options for renal failure are still limited. Gene expression profile analysis is powerful in the identification of biological differences between end stage renal failure patients and healthy controls. Previous studies mainly used variance/regression analysis without considering various biological, environmental factors. The purpose of this study is to investigate the gene expression difference between end stage renal failure patients and healthy controls with partial least squares (PLS) based analysis. METHODS With gene expression data from the Gene Expression Omnibus database, we performed PLS analysis to identify differentially expressed genes. Enrichment and network analyses were also carried out to capture the molecular signatures of renal failure. RESULTS We acquired 573 differentially expressed genes. Pathway and Gene Ontology items enrichment analysis revealed over-representation of dysregulated genes in various biological processes. Network analysis identified seven hub genes with degrees higher than 10, including CAND1, CDK2, TP53, SMURF1, YWHAE, SRSF1, and RELA. Proteins encoded by CDK2, TP53, and RELA have been associated with the progression of renal failure in previous studies. CONCLUSIONS Our findings shed light on expression character of renal failure patients with the hope to offer potential targets for future therapeutic studies. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1450799302127207.
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Affiliation(s)
| | | | | | - Ping Ma
- Department of medical laboratory, The affiliated hospital of Xuzhou Medical College, No,99 Huaihaixi Road, Xuzhou 221000, China.
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12
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Zhen J, Li Q, Zhu Y, Yao X, Wang L, Zhou A, Sun S. Increased serum CXCL16 is highly correlated with blood lipids, urine protein and immune reaction in children with active nephrotic syndrome. Diagn Pathol 2014; 9:23. [PMID: 24460887 PMCID: PMC3915750 DOI: 10.1186/1746-1596-9-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/15/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary nephrotic syndrome (NS) is a common disease in children. Lipid nephrotoxicity and cellular immune dysfunction are known features of this disease. Recently, CXCL16 was found to participate in inflammation and mediate cellular uptake of lipids. Here, we investigated the involvement of CXCL16 in the occurrence and development of primary NS. METHODS Serum CXCL16, blood lipids and albumin, 24-hour urine protein, interferon-γ and immune cells were detected in 25 children with steroid sensitive NS during their active nephrotic and remissive stages. Twenty healthy children served as the control group. RESULTS Levels of serum CXCL16, blood lipids, interferon-γ and CXCR6+ T cells were significantly increased and albumin and NK cell number were significantly decreased in the active status group compared with remissive status and control groups. Correlation analysis showed that serum CXCL16 was positively correlated with blood lipids, 24-hour urine protein, interferon-γ and CXCR6+ T cells but negatively correlated with albumin in patients with active NS. CONCLUSION Serum CXCL16 was increased in patients with active NS and correlated with blood lipids, urine protein and immune and inflammation responses, suggesting that CXCL16 may serve as a useful index or biomarker for disease activity in children with nephrotic syndrome. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1120468411154766.
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Affiliation(s)
| | | | | | | | | | | | - Shuzhen Sun
- School of Medicine, Shandong University, Jinan, China.
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13
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Kourelis TV, Gertz M, Zent C, Lacy M, Kyle R, Kapoor P, Zeldenrust S, Buadi F, Witzig T, Hayman S, Lust J, Russell S, Lin Y, Rajkumar VS, Kumar S, Leung N, Dingli D, Dispenzieri A. Systemic amyloidosis associated with chronic lymphocytic leukemia/small lymphocytic lymphoma. Am J Hematol 2013; 88:375-8. [PMID: 23508840 DOI: 10.1002/ajh.23413] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 12/22/2022]
Abstract
To clarify the presentation and course of patients with chronic lymphocytic leukemia (CLL) and amyloidosis. Mayo databases were interrogated for patients who carried a diagnosis of amyloidosis and CLL evaluated at Mayo Clinic, Rochester from January 1974 to October 2012. Charts were abstracted and data analyzed. Of the 33 patients identified, 20 (61%) were diagnosed with AL and 13 (39%) with non-AL. Only four patients had immunoglobulin light chain amyloidosis (AL) that could be solely attributed to the CLL clone; another six had both a plasma cell clone and a CLL clone that shared the same light chain. Median overall survival was 15.6 months for patients with AL and 58.1 months for patients with non-AL. For patients with AL management involved chemotherapy targeted toward monoclonal plasma cells, lymphocytes or both, and for patients with non-AL no specific amyloid treatment was administered. AL is a rare complication of CLL, but in this elderly population of patients non-AL is nearly as common. Distinguishing between these two groups is essential since patients with non-AL amyloidosis have better outcomes and they do not require cytotoxic chemotherapy to treat their amyloidosis.
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Affiliation(s)
| | - Morie Gertz
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Clive Zent
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Martha Lacy
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Robert Kyle
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Prashant Kapoor
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Steven Zeldenrust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Francis Buadi
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Thomas Witzig
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Suzanne Hayman
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - John Lust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Stephen Russell
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Yi Lin
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Vincent S. Rajkumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Shaji Kumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Nelson Leung
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - David Dingli
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Angela Dispenzieri
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
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14
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Wong E, Chew LP, Seymour JF. A case of chronic lymphocytic leukemia associated with systemic light chain amyloidosis. Leuk Lymphoma 2013; 54:2062-4. [PMID: 23320887 DOI: 10.3109/10428194.2013.765564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Ultrasound-guided percutaneous renal biopsy-induced accessory renal artery bleeding in an amyloidosis patient. Diagn Pathol 2012; 7:176. [PMID: 23231829 PMCID: PMC3564814 DOI: 10.1186/1746-1596-7-176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/03/2012] [Indexed: 11/10/2022] Open
Abstract
Abstract Ultrasound-guided percutaneous renal biopsy is an important technique for diagnosis of glomerular diseases, and the biopsy-induced life-threatening bleeding rarely happens. Primary systemic amyloidosis is a rare disease which may lead to organ dysfunction including arterial stiffness. The accessory renal artery is a kind of renal vascular variation which goes into the renal parenchyma directly or via the renal hilum. Here we reported a rare case of percutaneous renal biopsy-induced accessory renal artery life-threatening bleeding in a renal amyloidosis patient, and our experience of successful rescue in this patient. Virtual Slides http://www.diagnosticpathology.diagnomx.eu/vs/1524207344817819
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16
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Uprety D, Peterson A, Shah BK. Renal failure secondary to leukemic infiltration of kidneys in CLL--a case report and review of literature. Ann Hematol 2012; 92:271-3. [PMID: 22875063 DOI: 10.1007/s00277-012-1547-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/28/2012] [Indexed: 12/31/2022]
MESH Headings
- Acute Kidney Injury/etiology
- Acute Kidney Injury/therapy
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Delayed Diagnosis
- Humans
- Kidney/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemic Infiltration/pathology
- Lymph Nodes/pathology
- Male
- Renal Dialysis
- Rituximab
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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