Membranoproliferative glomerulonephritis and light-chain nephropathy in association with chronic lymphocytic leukemia.
The incidence of nephrotic syndrome co-existing with chronic lymphocytic leukemia (CLL) is a rare condition. Almost any glomerular pathology may accompany CLL. The most frequent of all is membranoproliferative glomerulonephritis (MPGN). Moreover, in 5 - 10% of patients with CLL, monoclonal gammopathy may be detected in serum and/or urine samples. There are no well-established treatment protocols for those CLL patients with accompanying nephrotic syndrome. In this case report, we present a 55-year-old female patient diagnosed with CLL, developing nephrotic syndrome, renal dysfunction and IgG k-type monoclonal gammopathy in the follow-up. The renal biopsy revealed glomerular and tubular deposits of k-chain and histopathology of membranoproliferative glomerulonephritis. Rituximab along with CVP (cyclophosphamide - vincristine - prednisolone) chemotherapy regimen was initiated. At the end of 6 courses of treatment, the patient was on "nephrologic" partial remission as the serum creatinine and albumin levels had returned to normal and proteinuria decreased by more than 50%. The patient was also in partial remission for CLL. In conclusion, in patients with CLL and nephrotic syndrome, presence of MPGN along with light-chain nephropathy is rarely reported. Several different treatment protocols are discussed for these patients. Among these regimes, R-CVP is an acceptable alternative for CLL patients with MPGN.
Mutluay
R
R
Department of Nephrology, Faculty of Medicine, Gazi University, Besevler Ankara, Turkey.
Aki
S Zeynep
SZ
Erten
Y
Y
Konca
C
C
Yagci
M
M
Barit
G
G
Sindel
S
S
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015432:Glomerulonephritis, Membranoproliferative / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000378:metabolism*; D007678:Kidney Glomerulus / Q000378:metabolism* / Q000473:pathology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D010265:Paraproteinemias / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007145:Immunoglobulin kappa-Chains; D000069283:Rituximab; D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone