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Currently filtering by tag: Lymphoma

Differential Diagnosis of Kidney Injury in CLL/SLL Patients

CLL/SLL, teaching points, arkana laboratories, renal pathology
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...

Granulomatous Interstitial Nephritis in CLL

Granulomatous Interstitial Nephritis in CLL
This is a renal biopsy from a 62-year-old female with a recent diagnosis of CLL/SLL, who presents with rapidly worsening renal function. The serum creatinine is 4.7 mg/dl (2.7 mg/dl 3 months prior). The biopsy shows a dense multifocal infiltrate of monomorphic small lymphocytes (Fig 1) which stain strongly positive for CD20 (Fig 4) and CD5 (not shown), and negative for CD3 (Fig 3). The background renal parenchyma shows moderate, mixed inflammation with scattered CD3 positive cells. Additionally, the interstitium multifocally shows granulomatous inflammation with giant cells (Fig 2). These findings are consistent with renal involvement by the patient’s know...

Intravascular Large B Cell Lymphoma

Intravascular Large B Cell Lymphoma, stained positive for CD20
A 75-year-old woman presented for her annual checkup with no complaints. She had a past medical history of hypertension and her blood pressure at this visit was 160/80. Laboratory findings were significant for an elevated serum creatinine at 2.1 mg/dL (baseline 1.0 mg/dL) as well as proteinuria of 855 mg/24 hr. All serologies, including proteinase-3, myeloperoxidase, and anti-nuclear antibodies were negative. A kidney biopsy was performed to evaluate the decreased kidney function and proteinuria. It revealed a total of five glomeruli were present, three of which showed a global endocapillary proliferation of large atypical cells with frequent mitotic figures (Photomicrographs...