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Kidney Week

Abstract: FR-PO670

Glomerulopathy, Lymphomatous Kidney Infiltration, and AKI as the First Sign of Relapsed Mantle Cell Lymphoma

Session Information

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Gutgarts, Victoria, Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medical College, New York, New York, United States
  • Shingarev, Roman A., Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Glezerman, Ilya, Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

Paraneoplastic glomerulopathy may be an early sign of malignancy. Membranous nephropathy (MN) is the most common glomerular disease reported with solid tumors and is rare in liquid tumors. We report a case of concomitant MN, lymphomatous infiltration, and acute kidney injury as the first sign of Mantle Cell Lymphoma (MCL) relapse.

Case Description

70-year-old male with Chronic Kidney Disease stage 3 and in remission from MCL treated with autologous stem cell transplant in 2011 presented with new shortness of breath for one week. His blood pressure was 160/90, pulse 110bpm, and oxygen saturation 96% on room air. He had pitting edema to the thighs and crackles at the lung bases. Significant laboratory values included serum creatinine of 8.0 (0.7-1.3)mg/dl, baseline of 3.0mg/dl, and serum albumin of 2.2 (3.8-5.0)g/dL. Urinary protein to creatinine (UPC) ratio was 22. Urine sediment showed 5RBCs and 0WBCs per HPF. Serum immunofixation was positive for IgM kappa. Serum kappa/lambda light chain ratio was 2.0 (16/8mg/dl). Patient underwent kidney biopsy which showed widespread lymphoma infiltration (figure below) and 8/11 glomeruli globally sclerosed, the remaining had capillary wall spikes, and subepithelial deposits on electron microscopy. Immunoflourescence showed inflammatory cells positive for IgM and kappa. PLA2R staining was weakly positive. The patient recieved methylprednisolone 1 gram for 3 days and acalabrutinib for his relapsed MCL. One week later, UPC was 12, but creatinine was unchanged likely due to ongoing lymphomatous infiltration.

Discussion

This case highlights the importance of clinician suspicion for relapsed disease in patients presenting with nephrotic syndrome and prior history of liquid tumor. This case is unique since the kidney biopsy showed two distinctive pathologic findings including subepithelial deposits consistent with secondary MN and lymphomatous infiltration of the parenchyma. Treatment should focus on the underlying malignancy where earlier detection may improve outcomes.

Infiltrating lymphoma and glomeruli with capillary wall thickening.