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August 29, 2018

Differential Diagnosis of Kidney Injury in CLL/SLL Patients

There are many causes of decreased kidney function in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and a renal biopsy may provide a definitive diagnosis.

Prerenal etiologies include poor oral intake, sepsis, and heart failure.  Intrarenal causes include diseases of the glomeruli (e.g. minimal change disease, MPGN pattern glomerulopathy, membranous glomerulopathy), tubules (e.g. toxic or ischemic tubular injury/necrosis, light chain cast nephropathy), interstitium (e.g. acute interstitial nephritis caused by infection or drugs), and vasculature (e.g. TMA).  The biopsy shown in this image illustrates infiltration of the kidney parenchyma by the lymphoid neoplasm (characteristic immunophenotypic studies not shown).  Postrenal causes include obstruction (e.g. extrarenal tumor mass, lymphadenopathy) and uric acid nephropathy related to tumor lysis syndrome, among others.

Reference

Rimda Wanchoo, et al.  Renal involvement in chronic lymphocytic leukemia.  Clinical Kidney Journal, sfy026, https://doi.org/10.1093/ckj/sfy026 (Advance article).