title: Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience.
abstract: While the renal complications of plasma cell dyscrasia have been well-described, most information in patients with chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis is derived from case reports. This is a retrospective analysis of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who underwent kidney biopsy for renal insufficiency and/or nephrotic syndrome. Between January 1995 and June 2014, 49 of 4,024 (1.2%) patients with chronic lymphocytic leukemia (n=44) or monoclonal B-cell lymphocytosis (n=5) had a renal biopsy: 34 (69%) for renal insufficiency and 15 (31%) for nephrotic syndrome. The most common findings on biopsy were: membranoproliferative glomerulonephritis (n=10, 20%), chronic lymphocytic leukemia interstitial infiltration as primary etiology (n=6, 12%), thrombotic microangiopathy (n=6, 12%), and minimal change disease (n=5, 10%). All five membranoproliferative glomerulonephritis patients treated with rituximab, cyclophosphamide and prednisone-based regimens had recovery of renal function compared to 0/3 patients treated with rituximab with or without steroids. Chronic lymphocytic leukemia infiltration as the primary cause of renal abnormalities was typically observed in relapsed/refractory patients (4/6). Thrombotic microangiopathy primarily occurred as a treatment-related toxicity of pentostatin (4/6 cases), and resolved with drug discontinuation. All cases of minimal change disease resolved with immunosuppressive agents only. Renal biopsy plays an important role in the management of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who develop renal failure and/or nephrotic syndrome.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Strati
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Samih H
authors.initials: SH
authors.lastname: Nasr
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Hanson
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Kari G
authors.initials: KG
authors.lastname: Chaffee
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schwager
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Achenbach
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Call
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Parikh
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Kay
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA shanafelt.tait@mayo.edu.
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000473:pathology; D008218:Lymphocytosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009404:Nephrotic Syndrome / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology; D015649:Pentostatin / Q000008:administration & dosage / Q000009:adverse effects; D051437:Renal Insufficiency / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage*
chemical_list: D015649:Pentostatin; D000069283:Rituximab