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Abstract: FR-PO682

Mantle Cell Lymphoma Resulting in Paraneoplastic Immune Complex Mediated Glomerulonephritis

Session Information

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Ahmad, Yahya Rauf, North Shore Medical Center, Salem, Massachusetts, United States
  • Motwani, Shveta S., Brigham and Women's Hospital and Dana-Farber Cancer Institute, Newton, Massachusetts, United States
  • Burdge, Kelly A., North Shore Physicians Group, Danvers, Massachusetts, United States
Introduction

Glomerulonephritis (GN) can result from paraneoplastic effect of certain malignancies. Here we report a case of a gentleman with Mantle cell lymphoma (MCL) who developed GN necessitating treatment of his cancer that otherwise did not meet hematological criteria for treatment.

Case Description

A 63-year Caucasian male with a newly diagnosed MCL, not on treatment, came in for evaluation of lower extremity edema within two weeks of diagnosis.
His edema was associated with a weight gain of ten pounds, and acute kidney injury with a creatinine rise from a baseline of 1.08 to 1.72, peaking at 3.14 mg/dL over the next few weeks. Initial evaluation consisted of a normal renal ultrasound, a urinalysis with 3+ blood, positive leukocyte esterase. A microscopic evaluation of his urine sediment showed dysmorphic red blood cells (RBCs), 5 white blood cells, and no bacteria. A spot urine protein to creatinine ratio of 5.3g/g creatinine of which 3.3g was albumin. Serological work up demonstrated a normal or negative serum and urine electrophoresis, serum free light chains, complements, anti- neutrophilic cytoplasmic antibody, anti-double stranded DNA, anti-glomerular basement membrane antibody, erythrocyte sedimentation rate, C-reactive protein, hepatitis serologies, lactate dehydrogenase, haptoglobin and cryoglobulin. His anti-nuclear antibody was weakly positive. He underwent a kidney biopsy showing acute tubular necrosis with immune complex GN with a focal proliferative and mesangioproliferative pattern of injury. There was no paraprotein deposition or parenchymal infiltration with the lymphoma cells. His GN was attributed to a paraneoplastic process resulting from his underlying MCL.
His GN prompted treatment with high dose steroids, bendamustine, and rituximab with improvement in creatinine to 1.2 mg/dL, and complete resolution of proteinuria. A subsequent positron emission tomography scan showed marked regression of his MCL.

Discussion

Renal involvement in mantle cell lymphoma is a rare complication. Mantle cell lymphoma is often an indolent condition that does not require treatment. However, organ-threatening GN such as that reported in our case can only respond to treatment. Serological studies are often insufficient and kidney biopsy is required for definitive diagnosis. Rituximab-based regimens are effective for treatment of paraneoplastic GN resulting from MCL.