[1604] Leukemia and Lymphoma-Associated Crescentic Glomerulonephritis

Mei Lin Z Bissonnette, Anthony Chang, Shane Meehan. University of Chicago, Chicago, IL

Background: A variety of glomerulopathies have been reported in association with hematologic diseases. Reports of crescentic glomerulonephritis (GN) occurring concurrently with hematologic malignancies are rare. We present a series of 3 cases of crescentic GN associated with leukemias and lymphomas.
Design: The clinical and pathologic data of 3 patients with hematologic malignancies and kidney biopsies showing crescentic GN were retrospectively reviewed. Biopsies were obtained between 2009 and 2011.
Results: The three cases of crescentic GN associted with leukemias and lymphoma are summarized in Table 1.

Summary of Crescentic GN Cases with Hematologic Malignancies
Case NumberAge/SexMalignancySCr (mg/dL)Kidney BiopsySerologyOutcome (After Biopsy)
148/FNatural killer (NK) cell leukemia2.4Focal crescentic GN, pauci-immuneANCA negativeDOD in 2 months
285/MAngioimmunoblastic T cell lymphoma (AITL)4.6Focal crescentic GN, with linear IgGANCA negative, Anti-GBM negativeDOD in 5 months
374/FB cell chronic lymphocytic leukemia (CLL)N/ADiffuse crescentic GN, with linear IgGN/ADOD in 9 months
SCr: serum creatinine, GN: glomerulonephritis, ANCA: anti-neutrophil cytoplasmic antibody, GBM: glomerular basement membrane, DOD: died of disease, N/A: not available

The kidney biopsies of cases 1 and 2 showed infiltration of kidney tissue by malignant cells while case 3 had no involvement by chronic lymphocytic leukemia. Patients 1 and 2 received several rounds of chemotherapy, and patient 3 was on hemodialysis in the months before death.
Conclusions: In this series of crescentic GN with hematologic malignancies we report 2 cases of anti-GBM GN associated with AITL and B cell CLL and a third case of pauci-immune GN associated with NK cell leukemia. Such lesions may arise in the absence of serologic evidence of disease. These rare lesions portend a poor prognosis for renal and patient survival, with time to death following kidney biopsy ranging from 2-9 months.
Category: Kidney (does not include tumors)

Monday, March 4, 2013 1:00 PM

Poster Session II # 234, Monday Afternoon

 

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