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Kidney Week

Abstract: PO2202

Direct Renal Infiltration in Chronic Lymphocytic Leukaemia: A Case Report

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Clince, Michelle, St Vincent's University Hospital, Dublin, Ireland
  • Holian, John N., St Vincent's University Hospital, Dublin, Ireland
Introduction

CLL is a haematological malignancy characterised by lymphocytosis with uncontrolled accumulation of B lymphocytes. It is most commonly a disease of older adults with co-morbidities limiting treatment options. Renal involvement of CLL is common with autopsy findings showing up to 90% involvement however direct infiltration rarely causes clinically significant renal impairment.

Case Description

A 78 year old man was admitted to hospital with acute on chronic kidney injury, creatinine 759umol/l from 200umol/L. He had background of CLL and a supra-pubic catheter. His total white cell count was 33.9x109/L and lymphocyte count of 19x109/L. His SPC was draining with no recent obstruction or infection. An US showed no hydronephrosis or cortical scarring. A renal biopsy was performed and a tunnelled dialysis catheter inserted to commence haemodialysis. Biopsy showed a diffuse heavy infiltrate of lymphoid cells in the intersitium with no immune deposition and 70% fibrosis. Immunohistochemistry staining positive for CD20 and CD5. We started a tyrosine kinase inhibitor however after 3 months he remained dialysis dependent and died from COVID pneumonia.

Discussion

Renal injury is seen in approximately 16.2% of patients during disease course in CLL. This can be due to tumour lysis syndrome, immune deposits, cyroglobinaemia, obstruction to due lymphadenopathy and direct infiltration of B lymphocytes as seen in this case. Indications for commencing treatment for CLL usually involve evidence of marrow failure, massive lymphadenopathy and significant B symptoms. In this case treatment was initiated to manage the patients' renal involvement. It is important to pursue a renal biopsy in patients with CLL as it may reveal an indication to commence treatment.

H&E shows heavy infiltrate of small lymphoid cells. ICH positive for CD20( B-cell marker) CD5 (expressed on normal T-lymphocytes but also expressed in CLL), mostly negative for CD3 (T-cell marker)