SUN-432 HEMATOLOGIC MALIGNANCIES IN RENAL BIOPSIES- EXPERIENCE IN AN ACADEMIC CENTER

Abstract

It is rare to have involvement of renal biopsies done for glomerulonephritis by hematologic malignancies. We present 4 diverse cases of hematologic malignancies with histologic and immunohistochemical evidence of renal involvement. These cases highlight the importance of a thorough evaluation of cellular infiltrates in renal biopsies along with clinical history. Electronic records for consecutive native and transplant renal biopsies from year 2015 to 2018 were reviewed. We noted 4 cases with non-myeloma malignancies. These included B-cell lymphomas and one case of acute myeloid leukemia. On evaluation, patients were noted to have systemic involvement. Routine evaluation of the kidney showed the renal tubulo-interstitium to be involved by B-cell lymphomas including CLL/SLL, mantle cell lymphoma and diffuse large B-cell lymphoma. In one case myeloid leukemic blasts were noted. Image from patient 4, shows presence of myeloid blasts in the renal biopsy that stain with CD34 and myeloperoxidase (MPO).Patient 4 : Myeloid blasts on H+E stain with large nuclei and prominent nucleoli. The blasts stain with CD34 and MPO. Key clinical and biopsy findings are presented below in Table 1. This case series demonstrates that malignant infiltration of the renal interstitium may result in acute kidney injury. The commonest causes are low-grade non-Hodgkin's lymphoma and acute lymphocytic leukemia. Renal biopsy findings may sometimes direct evaluation for an unsuspected hematologic malignancy, possibly allowing for earlier detection and improving patient outcome.