NDT Advance Access originally published online on November 12, 2007
Nephrology Dialysis Transplantation 2008 23(2):770-771; doi:10.1093/ndt/gfm617
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acute renal failure and chronic lymphocytic leukaemia
Email: william.clark{at}lhsc.on.ca
Sir,
Renal infiltration is often associated with chronic lymphocytic leukaemia (CLL). However, it is infrequently the direct cause of kidney failure. In CLL, post-renal obstruction with intra-abdominal [1–5] lymphadenopathy and/or increased incidence of uric stones, Bence–Jones proteinuria and/or cryoglobulinaemia can cause kidney failure indirectly [1,5].
Case
A 69-year-old man with a 2-year history of lymphoma had CT thorax/abdomen/pelvis from 2 years prior to our evaluation that revealed extensive lymphadenopathy consistent with a diagnosis of CLL. The patient had no known drug allergies and was not on medications. The patient had had a kidney biopsy 1 year prior to our evaluation that revealed severe tubulointerstitial nephritis and mild interstitial fibrosis. His creatinine had progressed from 214 to 279 over 6 months, until 3 months prior to this presentation. At this time, he presented with dysphagia, without haematemesis, fever or diarrhoea and his serum creatinine was noted to be greater than 900 mmol/l.
Investigations
Revealed a haemoglobin of 99, platelets 287 x 109/l, white cells 79.0 x 109/l, lymphocytes 56.2 x 109/l and presence of smudge cells. A CT of the abdomen and pelvis revealed extensive lymphadenopathy with bilaterally enlarged kidneys and no evidence of hydronephrosis. The patient did not demonstrate Bence–Jones proteinuria or cryoglobulinaemia and thus a kidney biopsy was performed (Figures 1 and 2). The pathology results indicated diffuse lymphocytic infiltrate consistent with B-cell lymphomproliferative, small cell type, in keeping with the diagnosis of CLL. Immunohistochemical study confirmed the diagnosis with positive staining of the neoplastic cells for CD20, CD79, CD5 and CD23.
|
|
Unfortunately, the patient adamantly declined chemotherapy and haemodialysis was initiated. At present time, he remains dialysis-dependent.
Discussion
In the absence of other obvious explanations for this patient's acute renal failure, we presume that it is secondary to malignant infiltration by his CLL. However, we could not confirm this by treatment with chemotherapy, due to the patient's adamant refusal. In hind-sight, it is presumed that his previously diagnosed tubulointerstitial nephritis was the early manifestation of his lymphocytic renal infiltration due to his CLL.
Conflict of interest statement. None declared.
Department of Medicine,
Division of Nephrology,
London Health Science centre,
Victoria Hospital,
800 Commissioners Road E,
London,
ON N6A 4G5
Notes
See http://ndtplus.oxfordjournals.org/
References
- Erten N, Saka B, Caliskan YK, Besisik S, Karan MA, Tascioglu C. Acute renal failure due to leukaemic infiltration in chronic lymphocytic leukaemia: case report. Int J Clin Pract Suppl (2005) 147:53–55.[Medline]
- Phillips JK, Bass PS, Majumdar G, Davies DR, Jones NF, Pearson TC. Renal failure caused by leukaemic infiltration in chronic lymphocytic leukaemia. J Clin Pathol (1993) 46:1131–1133.
[Abstract/Free Full Text] - Da’as N, Polliak A, Cohen Y, et al. Kidney involvement and renal manifestations in non-Hodgkin's lymphoma and lymphocytic leukemia: a retrospective study. Eur J Haematol (2001) 67:158–164.[CrossRef][Web of Science][Medline]
- Obrador GT, Price B, O’Meara Y, Salant DJ. Acute renal failure due to lymphomatous infiltration of the kidneys. J Am Soc Nephrol (1997) 8:1348–1354.[Abstract]
- Lommatzsch SE, Bellizzi AM, Cathro HP, Rosner MH. Acute renal failure caused by renal infiltration by hematolymphoid malignancy. Ann Diagn Pathol (2006) 10:230–234.[Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||