Abstract
BackgroundRenal failure due to the infiltration of chronic lymphocytic leukemia (CLL) cells into the tubulointerstitial area of the kidney is uncommon. Furthermore, granulomatous interstitial nephritis (GIN) is a rare histological diagnosis in patients undergoing a renal biopsy. We herein report a case of GIN due to the diffuse infiltration of CLL cells in a patient who developed progressive renal failure.Case presentationThe patient was a 55-year-old man who had been diagnosed with CLL 4 years earlier and who had been followed up without treatment. Although his serum creatinine level had remained normal for three and a half years, it started to increase in the six months prior to his presentation. A urinalysis showed mild proteinuria without any hematuria at the time of presentation. A renal biopsy revealed the diffuse infiltration of CLL cells into the tubulointerstitial area with non-caseating epithelioid cell granulomas. Despite cyclophosphamide treatment, his renal function did not improve, and he ultimately required maintenance hemodialysis.ConclusionWhen progressive renal failure is combined with CLL, GIN due to the direct infiltration of CLL cells should be considered as a differential diagnosis.
Highlights
Renal failure due to the infiltration of chronic lymphocytic leukemia (CLL) cells into the tubulointerstitial area of the kidney is uncommon
When progressive renal failure is combined with CLL, granulomatous interstitial nephritis (GIN) due to the direct infiltration of CLL cells should be considered as a differential diagnosis
We determined that progressive renal dysfunction had occurred due to the diffuse infiltration of CLL cells in the interstitial area of the kidneys, and the patient was treated with two cycles of cyclophosphamide
Summary
Chronic lymphocytic leukemia (CLL) mainly invades the lymph nodes, bone marrow, liver, and spleen; extramedullary lesions of CLL are uncommon in the clinical setting. Kidney infiltration is found on autopsy in 63%–90% of CLL patients [2,3,4]; the lesions are nodular or diffuse in the subcapsular cortex, cortico-medullary junction or along the vasa recta [3] These lesions seldom lead to end-stage renal failure [5]. Peripheral blood flow cytometry revealed that the percentages of lymphocytes that were positive for cluster of differentiation (CD), CD19, CD20, and CD23 to be 97.5%, 91.7%, 80.7%, and 84.3%, respectively He was diagnosed with CLL Rai stage II. We determined that progressive renal dysfunction had occurred due to the diffuse infiltration of CLL cells in the interstitial area of the kidneys, and the patient was treated with two cycles of cyclophosphamide. The treatment was unable to attenuate the progression of the renal dysfunction, and the patient required maintenance hemodialysis due to end-stage renal failure
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