Abstract
BackgroundChronic 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.MethodsFifteen CLL/SLL patients with kidney biopsy were identified retrospectively. Demographic, clinical, pathological and laboratory data were assessed at biopsy, and during follow-up.ResultsAt 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.ConclusionsA broad spectrum of kidney diseases is associated with CLL/SLL. In this setting, kidney biopsy can provide important information for diagnosis and therapeutic guidance.
Highlights
Kidney diseases are frequently associated with hematologic malignancies
A broad spectrum of kidney diseases is associated with Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
Unlike renal involvement in monoclonal gammapathies, the description of kidney diseases associated with CLL/SLL is currently limited to case reports and small series of immune-mediated glomerulopathies and interstitial infiltration by monoclonal lymphocytes [3,4,5,6,7,8,9]
Summary
Kidney diseases are frequently associated with hematologic malignancies. Depending on the type and stage of the malignancy, the spectrum of kidney pathology can be wide, including immune-mediated glomerulonephritis, interstitial monoclonal infiltration and tubular obstruction.Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are two different presentations of the most frequent B-cell neoplasm in adults in Western countries, with an annual incidence of 4–30 cases per 100,000 persons per year [1,2]. Unlike renal involvement in monoclonal gammapathies, the description of kidney diseases associated with CLL/SLL is currently limited to case reports and small series of immune-mediated glomerulopathies and interstitial infiltration by monoclonal lymphocytes [3,4,5,6,7,8,9]. In this context, the objective of the present study was to provide a systematic description of kidney pathology and clinical characteristics in a well characterized population of CLL/SLL patients referred for kidney biopsy, in order to better delineate the spectrum and the relative frequency of kidney diseases associated with CLL/SLL. This study provides a clinicopathological analysis of all-cause kidney disease in CLL/SLL patients
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