1
|
Cyclin-D1 positive B cell lymphoma with intravascular and interstitial involvement of kidney and bone marrow. Int J Hematol 2023; 117:925-928. [PMID: 36626027 DOI: 10.1007/s12185-023-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
Kidney involvement is rare in non-Hodgkin's lymphomas (NHL), and can be caused by direct lymphoid infiltration, paraneoplastic glomerulonephritis (GN), or both. Herein, we present a case of acute kidney injury (AKI) due to renal cyclin-D1 positive B cell lymphoma infiltration. To our knowledge, this is the first case where a renal biopsy revealed intravascular neoplastic cells along with parenchymal infiltration.
Collapse
|
2
|
Zhao ZY, Tang N, Fu XJ, Lin LE. Secondary light chain amyloidosis with Waldenström’s macroglobulinemia and intermodal marginal zone lymphoma: A case report. World J Clin Cases 2022; 10:10779-10786. [PMID: 36312489 PMCID: PMC9602216 DOI: 10.12998/wjcc.v10.i29.10779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The co-existence of Waldenström’s macroglobulinemia (WM) with internodal marginal zone lymphoma (INMZL) is rare and often associated with poor prognosis.
CASE SUMMARY We present a Chinese female patient who developed secondary light chain amyloidosis due to WM and INMZL and provides opinions on its systemic treatment. A 65-year-old woman was diagnosed with WM 6 years ago and received Bruton tyrosine kinase inhibitor monotherapy for two years. Her INMZL was confirmed due to left cervical lymphadenopathy. The patient presented with oedema in both lower limbs one year ago, and was diagnosed with secondary light chain amyloidosis. Treatment with the BC regimen (rituximab 375 mg/m2 monthly for 6-8 courses, and bendamustine 90 mg/m2 per day × 2, monthly for six courses) was initiated, but not tolerated due to toxic side effects. Bortezomib-based therapy was given for two months, including bortezomib, dexamethasone, and zanubrutinb. Oedema in both lower limbs was relieved and treatment efficacy was evaluated as partial remission.
CONCLUSION A detailed clinical evaluation and active identification of the aetiology are recommended to avoid missed diagnosis and misdiagnosis.
Collapse
Affiliation(s)
- Zhen-Yu Zhao
- Department of Hematology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Nan Tang
- Department of Emergency Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Xiang-Jun Fu
- Department of Hematology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Li-Er Lin
- Department of Hematology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| |
Collapse
|
3
|
Nie G, Sun L, Zhang C, Yuan Y, Mao H, Wang Z, Li J, Duan S, Xing C, Zhang B. Clinicopathological features and individualized treatment of kidney involvement in B-cell lymphoproliferative disorder. Front Immunol 2022; 13:903315. [PMID: 36172352 PMCID: PMC9510618 DOI: 10.3389/fimmu.2022.903315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Due to the various clinical and pathological manifestations of kidney involvement in lymphoproliferative disorder (LPD), the whole spectrum of kidney disease in LPD is still unclear, and data on kidney prognosis is scarce. Methods We retrospectively reviewed the renal pathology profiles from January 2010 to December 2021, and 28 patients with B-cell LPD combined with intact renal biopsy data were included. Results There were 20 men and eight women aging 41 to 79 years at the time of renal biopsy (median age 62 years). According to hematological diagnosis, patients were classified into four groups: chronic lymphocytic leukemia (CLL) (group1, n=7), Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) (group 2, n=8; WM, n=6; LPL, n=2), Other non-Hodgkin’s lymphomas (NHL) (group3, n=7; diffuse large B-cell lymphoma (DLBCL), n=2; mucosa-associated lymphoid tissue (MALT) lymphoma, n=4; Low grade B-cell lymphoma, n=1), and monoclonal gammopathy of undetermined significance/monoclonal gammopathy of renal significance (MGUS/MGRS) (group 4, n=6). Median serum creatinine (Scr) level was 129 (range,59-956) umol/L. Eight patients (29%) were presented with acute kidney injury (AKI), and five patients (18%) required hemodialysis upon admission. Twenty-three patients (82%) presented with proteinuria (median protein excretion, 2.14 g/d), 11(39%) of whom had the nephrotic syndrome. Interstitial malignant infiltration was the most frequent renal lesion (n=6). Eight patients underwent immunohistochemistry of renal tissues, of which three patients (CLL, n=1; LPL, n=1; WM, n=1) had confirmed lymphoma infiltrates, and the infiltrating cells in the remaining five patients (CLL, n=1; MALT lymphoma, n=2; MGUS, n=2) were considered unrelated to lymphoma. The most common glomerular diseases were renal amyloidosis (n=4) and membranous nephropathy (n=4). Only 20 patients were treated, 13 of whom were treated with rituximab separately or in combination. The median follow-up time was 11 months. Of these, six had achieved hematological response, complete response in five cases. Eight had achieved renal response. At the end-of-study visit, four patients died and two progressed to end stage kidney disease (ESKD). Conclusion In conclusion, the clinicopathological spectrum of renal involvement in BLPD is diverse. Renal biopsy and immunohistochemistry are required for early diagnosis and prognostic assessment.
Collapse
Affiliation(s)
- Guangyan Nie
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lianqin Sun
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Suyan Duan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| | - Bo Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Nephrology, Pukou Branch of JiangSu Province Hospital (Nanjing Pukou Central Hospital), Nanjing, China
- *Correspondence: Bo Zhang, ; Suyan Duan, ; Changying Xing,
| |
Collapse
|
4
|
Renal involvement of lymphomas proven by kidney biopsy: report of 10 cases from a tertiary care center and comparison with the literature. Int J Hematol 2022; 116:678-695. [PMID: 35829895 DOI: 10.1007/s12185-022-03411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
Lymphomas localized in the kidney are a rare entity that may be challenging to diagnose. We analyzed data from 10 patients with renal involvement of lymphoma diagnosed between 2009 and 2019 on fine needle biopsy from our tertiary center, and compared these with findings of 160 cases reported in the literature. Diffuse large B-cell lymphoma was the main histology subtype (40 and 38% in our sample and in the literature, respectively), followed by low-grade B-cell lymphomas, mostly from the marginal zone (MZ). Altogether, 106 patients had urological inaugural symptoms and 64 had general symptoms. Patients with urological presentation more often had renal masses than diffuse infiltration (p < 0.001), unilateral tumors (p = 0.0036) and low-grade B-cell lymphomas (17 vs 6%, p = 0.043). In both groups, nearly one-fourth of patients had diffuse (stage IV) lymphomas. Overall survival did not differ by the presence of urological/systemic symptoms, stage or aggressive lymphoma status. Notably, 3 of 10 patients from our series had MZ lymphomas associated with primary Sjögren syndrome revealed by acute kidney injury, including one where the autoimmune disease was detected. Lymphoproliferative disorders localized in the kidney are a challenging condition that can lead to detection of aggressive or diffuse lymphomas.
Collapse
|
5
|
Tsutsué S, Makita S, Yi J, Crawford B. Cost drivers associated with diffuse large B-cell lymphoma (DLBCL) in Japan: A structural equation model (SEM) analysis. PLoS One 2022; 17:e0269169. [PMID: 35622820 PMCID: PMC9140275 DOI: 10.1371/journal.pone.0269169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin’s lymphoma of increasing prevalence in Japan. However, patients with relapsed or refractory disease to first line treatment (rrDLBCL) have been found to shoulder greater economic burden and have poor survival with subsequent lines of therapy. The relative impact of individual patient attributes on total medical cost among patients with rrDLBCL receiving second or third line (2L/3L) therapy was assessed. Structural equation modelling was used to identify potential cost drivers of total medical costs incurred by treatment and procedures in a Japanese retrospective claims database. From the database, rrDLBCL patients on 2L or 3L of treatment were grouped into respective cohorts. The mean [median] (SD) total medical cost of care for the 2L cohort was 73,296.40 [58,223.11] (58,409.79) US dollars (USD) and 75,238.35 [60,477.31] (59,583.66) USD for the 3L cohort. The largest total effect on medical cost in both cohorts was length of hospital stay (LOS) (β: 0.750 [95%CI: 0.728, 0.772] vs β: 0.762 [95%CI: 0.729, 0.794]). Length of hospital stay and potential heart disease complications due to line of treatment were the primary drivers of total cost for patients who had received at least 2L or 3L therapy for rrDLBCL.
Collapse
Affiliation(s)
- Saaya Tsutsué
- Celgene K.K., a Bristol Myers Squibb Company, Tokyo, Japan
- * E-mail:
| | | | | | | |
Collapse
|
6
|
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.
Collapse
|
7
|
Sy-Go JPT, Herrmann SM, Seshan SV. Monoclonal Gammopathy-Related Kidney Diseases. Adv Chronic Kidney Dis 2022; 29:86-102.e1. [PMID: 35817530 DOI: 10.1053/j.ackd.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/09/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022]
Abstract
Monoclonal gammopathies occur secondary to a broad range of clonal B lymphocyte or plasma cell disorders, producing either whole or truncated monoclonal immunoglobulins. The kidneys are often affected by these monoclonal proteins, and, although not mutually exclusive, can involve the glomeruli, tubules, interstitium, and vasculature. The nephrotoxic potential of these monoclonal proteins is dependent on a variety of physicochemical characteristics that are responsible for the diverse clinicopathologic manifestations, including glomerular diseases with organized deposits, glomerular diseases with granular deposits, and other lesions, such as C3 glomerulopathy and thrombotic microangiopathy with unique pathophysiologic features. The diseases that involve primarily the tubulointerstitial and vascular compartments are light chain cast nephropathy, light chain proximal tubulopathy, crystal-storing histiocytosis, and crystalglobulin-induced nephropathy with distinct acute and chronic clinicopathologic features. The diagnosis of a monoclonal gammopathy-related kidney disease is established by identification of an underlying active or more commonly, low-grade hematologic malignancy, serologic evidence of a monoclonal gammopathy when detectable, and most importantly, monoclonal protein-induced pathologic lesions seen in a kidney biopsy, confirming the association with the monoclonal protein. Establishing a diagnosis may be challenging at times, particularly in the absence of an overt hematologic malignancy, with or without monoclonal gammopathy, such as proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Overall, the treatment is directed against the underlying hematologic disorder and the potential source of the monoclonal protein.
Collapse
Affiliation(s)
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
| | - Surya V Seshan
- Department of Anatomic Pathology and Clinical Pathology, Weil Cornell Medical College, New York, NY
| |
Collapse
|
8
|
Swain M, Nuguri S, De Padua M, Gowrishankar S. Renal lymphoma diagnosed on kidney biopsy presenting as acute kidney injury. Indian J Nephrol 2022; 32:342-347. [PMID: 35967526 PMCID: PMC9364996 DOI: 10.4103/ijn.ijn_345_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction: Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal. Methods: This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury. Results: The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1–9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis. Conclusion: Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.
Collapse
|
9
|
Melilli E, Mussetti A, Linares GS, Ruella M, La Salette C, Savchenko A, Taco MDR, Montero N, Grinyo J, Fava A, Gomà M, Meneghini M, Manonelles A, Cruzado J, Sureda A, Bestard O. Acute Kidney Injury Following Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphoma in a Kidney Transplant Recipient. Kidney Med 2021; 3:665-668. [PMID: 34401733 PMCID: PMC8350835 DOI: 10.1016/j.xkme.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a newer and effective therapeutic option approved for patients with relapsed/refractory acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Acute kidney injury is a complication of CAR T-cell therapy that can result in kidney failure. In most cases, it is thought to be related to hemodynamic changes due to cytokine release syndrome. Kidney biopsy in this clinical scenario is usually not performed. We report on a kidney transplant recipient in his 40s who developed a posttransplant lymphoproliferative disorder of B-cell origin refractory to conventional treatments and received anti-CD19 CAR T-cell therapy as compassionate treatment. Beginning on day 12 after CAR T-cell infusion, in the absence of clinical symptoms, a progressive decline in estimated glomerular filtration rate of the kidney graft occurred. A subsequent allograft biopsy showed mild tubulointerstitial lymphocyte infiltrates, falling into a Banff borderline-changes category and resembling an acute immunoallergic tubulointerstitial nephritis. Neither CAR T cells nor lymphomatous B cells were detected within the graft cellular infiltrates, suggesting an indirect mechanism of kidney injury. Although kidney graft function partially recovered after steroid therapy, the posttransplant lymphoproliferative disorder progressed and the patient died 7 months later.
Collapse
Affiliation(s)
- Edoardo Melilli
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
- Institut de Investigació Biomedica de Bellvitge (IDIBELL)–Hospitalet, Barcelona, Spain
| | - Alberto Mussetti
- Institut de Investigació Biomedica de Bellvitge (IDIBELL)–Hospitalet, Barcelona, Spain
- Clinical Hematology Department, Institut Català d'Oncologia–Hospitalet, Barcelona, Spain
| | - Gabriela Sanz Linares
- Institut de Investigació Biomedica de Bellvitge (IDIBELL)–Hospitalet, Barcelona, Spain
- Clinical Hematology Department, Institut Català d'Oncologia–Hospitalet, Barcelona, Spain
| | - Marco Ruella
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Nuria Montero
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Josep Grinyo
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Alex Fava
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Montse Gomà
- Pathology Department, Bellvitge University Hospital–Hospitalet, Barcelona, Spain
| | - Maria Meneghini
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Josepmaria Cruzado
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
| | - Ana Sureda
- Institut de Investigació Biomedica de Bellvitge (IDIBELL)–Hospitalet, Barcelona, Spain
- Clinical Hematology Department, Institut Català d'Oncologia–Hospitalet, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Bellvitge University Hospital–Hospitale, Barcelona, Spain
- Institut de Investigació Biomedica de Bellvitge (IDIBELL)–Hospitalet, Barcelona, Spain
| |
Collapse
|
10
|
Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits. Diagnostics (Basel) 2021; 11:diagnostics11040710. [PMID: 33921123 PMCID: PMC8071536 DOI: 10.3390/diagnostics11040710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.
Collapse
|
11
|
Bridoux F, Cockwell P, Glezerman I, Gutgarts V, Hogan JJ, Jhaveri KD, Joly F, Nasr SH, Sawinski D, Leung N. Kidney injury and disease in patients with haematological malignancies. Nat Rev Nephrol 2021; 17:386-401. [PMID: 33785910 DOI: 10.1038/s41581-021-00405-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is common in patients with cancer, especially in those with haematological malignancies. Kidney injury might be a direct consequence of the underlying haematological condition. For example, in the case of lymphoma infiltration or extramedullary haematopoiesis, it might be caused by a tumour product; in the case of cast nephropathy it might be due to the presence of monoclonal immunoglobulin; or it might result from tumour complications, such as hypercalcaemia. Kidney injury might also be caused by cancer treatment, as many chemotherapeutic agents are nephrotoxic. High-intensity treatments, such as high-dose chemotherapy followed by haematopoietic stem cell transplantation, not only increase the risk of infection but can also cause AKI through various mechanisms, including viral nephropathies, engraftment syndrome and sinusoidal obstruction syndrome. Some conditions, such as thrombotic microangiopathy, might also result directly from the haematological condition or the treatment. Novel immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T cell therapy, can also be nephrotoxic. As new therapies for haematological malignancies with increased anti-tumour efficacy and reduced toxicity are developed, the number of patients receiving these treatments will increase. Clinicians must gain a good understanding of the different mechanisms of kidney injury associated with cancer to better care for these patients.
Collapse
Affiliation(s)
- Frank Bridoux
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France.,CNRS, UMR7276, Limoges, France.,Centre de référence Amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales, Poitiers, France
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ilya Glezerman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Victoria Gutgarts
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Jonathan J Hogan
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Florent Joly
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
12
|
Cheung CY, Tang AHC, Wong YT, Chan GSW, Tang SCW. Clinicopathological features of Chinese patients with B-cell lymphoproliferative disorders and kidney infiltration. Nephrology (Carlton) 2021; 26:650-658. [PMID: 33729651 DOI: 10.1111/nep.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022]
Abstract
AIM Direct kidney involvement in B-cell lymphoproliferative disease is a rare disorder with only a few studies reported in Caucasian patients. The clinicopathological characteristics and outcome of this entity remain poorly described. METHODS We retrospectively studied all adult Chinese patients who had histology-proven renal parenchymal infiltration by malignant B-cells between 1 January 2000 and 31 December 2018 at two tertiary hospitals in Hong Kong. Clinical, pathological and radiological data were collected from 20 patients. Follow-up data were analysed until 31 December 2019. RESULTS Median follow-up duration was 22 (1-171) months. Only seven patients (35%) had established diagnosis of haematological cancer before kidney biopsy. Diffuse large B-cell lymphoma (DLBCL) was the most common subtype in our cohort (n = 5, 25%). Others included low-grade B-cell lymphoma (n = 11), intravascular large B-cell lymphoma (n = 1), mantle cell lymphoma (n = 1) and multiple myeloma (n = 2). Fourteen patients (70%) presented with AKI while 12 patients (60%) had proteinuria. Seven patients (35%) had unilateral renal mass, one had bilateral renal masses and one had bilateral diffuse nephromegaly in computed tomography. Lymphomatous tubulointerstitial infiltration was the prevalent histological finding. Nine patients (45%) had coexisting renal lesions other than direct tumour infiltration. All but one patient received chemotherapy. Ten patients died and renal responders had a significantly better survival than non-renal responders (p = .03). CONCLUSION Direct tumour infiltration can occur in a wide variety of B-cell lymphoproliferative disorders. Coexisting immunoglobulin-related nephropathy is frequently found. Renal biopsy is required for early diagnosis which allows timely and appropriate treatment.
Collapse
Affiliation(s)
- Chi Yuen Cheung
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Arthur H C Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yuen Ting Wong
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Gavin S W Chan
- Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| |
Collapse
|
13
|
Puigrenier S, Gnemmi V, Gibier JB, Dubois R, Collet G, Tricot S, Quémeneur T, Ulrich M. [Intravascular large B cell lymphoma pathological findings led by positron emission tomography findings: About one case]. Nephrol Ther 2020; 16:372-375. [PMID: 32753278 DOI: 10.1016/j.nephro.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/07/2020] [Accepted: 03/29/2020] [Indexed: 10/23/2022]
Abstract
Intravascular large B cell lymphoma is a rare non-Hodgkin large B cell lymphoma disease, with heterogeneous clinical manifestation and difficult pathological diagnosis. Positron emission tomography may be helpfull in this context and has already been reported. A 45-year-old woman was admitted for persistent high fever, inflammatory syndrome and unexplained haemophagocytic syndrome. Bilateral cortical renal hypermetabolism at positron emission tomography initially misled to pyelonephritis diagnosis and secondarily led to kidney biopsy, which showed intravascular large B cell lymphoma. Renal involvement in intravascular large B cell lymphoma is rare and is usually characterized by acute renal failure and proteinuria. Global hypermetabolism at positron emission tomography has already been described in this context, but cortical hypermetabolism has never been associated with pathological findings. In front of persistent high fever without etiology, this positron emission tomography feature must lead to intravascular large B cell lymphoma suspicion and to kidney biopsy to obtain pathological proof.
Collapse
Affiliation(s)
- Sébastien Puigrenier
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Viviane Gnemmi
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Jean-Baptiste Gibier
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Romain Dubois
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Guillaume Collet
- Service de médecine nucléaire, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Sabine Tricot
- Service d'hématologie, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Thomas Quémeneur
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Marc Ulrich
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France.
| |
Collapse
|
14
|
Javaugue V, Dufour-Nourigat L, Desport E, Sibille A, Moulin B, Bataille P, Bindi P, Garrouste C, Mariat C, Karlin L, Nouvier M, Goujon JM, Gnemmi V, Fermand JP, Touchard G, Bridoux F. Results of a nation-wide cohort study suggest favorable long-term outcomes of clone-targeted chemotherapy in immunotactoid glomerulopathy. Kidney Int 2020; 99:421-430. [PMID: 32739419 DOI: 10.1016/j.kint.2020.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
Abstract
Immunotactoid glomerulopathy is a rare disease defined by glomerular microtubular immunoglobulin deposits. Since management and long-term outcomes remain poorly described, we retrospectively analyzed results of 27 adults from 21 departments of nephrology in France accrued over 19 years. Inclusion criteria were presence of glomerular Congo red-negative monotypic immunoglobulin deposits with ultrastructural microtubular organization, without evidence for cryoglobulinemic glomerulonephritis. Baseline manifestations of this cohort included: proteinuria (median 6.0 g/day), nephrotic syndrome (70%), microscopic hematuria (74%) and hypertension (56%) with a median serum creatinine of 1.5 mg/dL. Nineteen patients had detectable serum and/or urine monoclonal gammopathy. A bone marrow and/or peripheral blood clonal disorder was identified in 18 cases (16 lymphocytic and 2 plasmacytic disorders). Hematologic diagnosis was chronic/small lymphocytic lymphoma in 13, and monoclonal gammopathy of renal significance in 14 cases. Kidney biopsy showed atypical membranous in 16 or membranoproliferative glomerulonephritis in 11 cases, with microtubular monotypic IgG deposits (kappa in 17 of 27 cases), most commonly IgG1. Identical intracytoplasmic microtubules were observed in clonal lymphocytes from 5 of 10 tested patients. Among 21 patients who received alkylating agents, rituximab-based or bortezomib-based chemotherapy, 18 achieved a kidney response. After a median follow-up of 40 months, 16 patients had sustained kidney response, 7 had reached end-stage kidney disease, and 6 died. Chronic/small lymphocytic lymphoma appears as a common underlying condition in immunotactoid glomerulopathy, but clonal detection remains inconstant with routine techniques in patients with monoclonal gammopathy of renal significance. Thus, early diagnosis and hematological response after clone-targeted chemotherapy was associated with favorable outcomes. Hence, thorough pathologic and hematologic workup is key to the management of immunotactoid glomerulopathy.
Collapse
Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Centre National de la Recherche Scientifique UMR 7276, Institut National de la Santé et de la Recherche Médicale UMR 1262, Contrôle de la réponse immune B et lymphoproliférations, Limoges, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Institut National de la Santé et de la Recherche Médicale CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Léa Dufour-Nourigat
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Audrey Sibille
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Bruno Moulin
- Department of Nephrology, Centre Hospitalier Universitaire, Strasbourg, France
| | - Pierre Bataille
- Department of Nephrology, Centre Hospitalier Général, Boulogne-sur-Mer, France
| | - Pascal Bindi
- Department of Nephrology, Centre Hospitalier Général, Verdun, France
| | - Cyril Garrouste
- Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Christophe Mariat
- Department of Nephrology, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Lionel Karlin
- Department of Clinical Hematology, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Mathilde Nouvier
- Department of Nephrology, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Jean-Michel Goujon
- Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Viviane Gnemmi
- Department of Pathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Centre National de la Recherche Scientifique UMR 7276, Institut National de la Santé et de la Recherche Médicale UMR 1262, Contrôle de la réponse immune B et lymphoproliférations, Limoges, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Institut National de la Santé et de la Recherche Médicale CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| |
Collapse
|
15
|
Ville S, Kandel C, Delaunay J, Cantarovich D. IgGκ light and heavy chain amyloidosis secondary to a B-cell lymphoproliferative disorder, whole picture on a renal biopsy. Nephrology (Carlton) 2019; 25:429-430. [PMID: 31726478 DOI: 10.1111/nep.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Simon Ville
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | | | | | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| |
Collapse
|