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June 21, 2017

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

This renal biopsy was taken from an 82-year-old man with acute renal failure and nephrotic range proteinuria. His past medical history included chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The biopsy shows an involvement of the renal cortex by a monomorphic population of small lymphoid cells, the morphology and immunophenotype of which were diagnostic of CLL/SLL. In addition, glomeruli showed a diffuse membranoproliferative glomerulonephritis (MPGN) pattern of injury with associated immune deposits. In a study by Da’as et al., more than 10% of patients with non-Hodgkin lymphoma developed acute renal failure. More recent work by Kowalewska et al. describes the spectrum of glomerular injury in patients with renal involvement by lymphoid neoplasms, including paraprotein-related disease, membranous glomerulopathy, and MPGN-pattern glomerulonephritis, which was observed in this biopsy.

References:
Da’as N, Polliack A, Cohen Y, Amir G, Darmon D, Kleinman Y, Goldfarb AW, Ben-Yehuda D. Kidney involvement and renal manifestations in non-Hodgkin’s lymphoma and lymphocytic leukemia: a retrospective study in 700 patients. Eur J Haematol. 2001 Sep;67(3):158-64.
https://www.ncbi.nlm.nih.gov/pubmed/11737248/

Kowalewska J, Nicosia RF, Smith KD, Kats A, Alpers CE. Patterns of glomerular injury in kidneys infiltrated by lymphoplasmacytic neoplasms. Hum Pathol. 2011 Jun;42(6):896-903.https://www.ncbi.nlm.nih.gov/pubmed/21288559