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Kidney Week

Abstract: PO2212

Renal Involvement as Initial Presentation of Mantle Cell Lymphoma: A Case Series

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

  • El Halabi, Ibrahim, Albany Medical Center, Albany, New York, United States
  • Rigual Soler, Natacha, Albany Medical Center, Albany, New York, United States
  • Gosmanova, Elvira O., Albany Stratton VA Medical Center, Albany, New York, United States
  • Mehta, Swati, Albany Medical Center, Albany, New York, United States
  • Lightle, Andrea R., Albany Medical Center, Albany, New York, United States
  • Salman, Loay H., Albany Medical Center, Albany, New York, United States
  • Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States
Introduction

Mantle cell lymphoma (MCL) rarely affects kidneys. We present 2 cases with different spectrum of kidney involvement in MCL.

Case Description

The 1st case was a 63-yr old male with incidental finding of Serum creatinine (SCr) of 10mg/dL. Chronic lymphocytic leukemia was diagnosed 2 weeks prior via peripheral blood cell analysis & flow cytometry (FC) done due to constitutional symptoms and headaches for which he was using daily ibuprofen for several months. On exam he had elevated blood pressure but no signs of volume overload. Initial supportive treatment did not improve kidney function and hemodialysis was initiated due to worsening azotemia and persistent nausea and vomiting suspicious for uremia. Renal biopsy showed diffuse acute on chronic interstitial nephritis with perivascular lymphoid aggregates of monoclonal CD 20+ B-cells positive for CD5 and Cyclin-D1 consistent with MCL. No significant immunostaining was found. Bone marrow biopsy confirmed renal biopsy findings and diagnosis of MCL. Until last follow up, the patient refused chemotherapy and remained dialysis dependent.
The 2nd case was a 73-yr old male with incidental founding of SCr of 1.9mg/dL in association with glomerular hematuria and grade A3 proteinuria. He had no constitutional symptoms and had normal physical exam except for presence of diffuse lymph node (LN) enlargement. Renal biopsy was obtained and showed MPGN-pattern with 25% crescents on light microscopy, presence of all immunoglobulin classes with κ-light chain (KLC) predominance in glomeruli and lymphoid infiltration with KLC in the interstitium on immunostaining. MCL was confirmed with FC and excisional LN biopsy. Prednisone/Rituximab/Bendamustine therapy led to improvement in kidney function and proteinuria.

Discussion

MCL can cause differential kidney involvement from direct tumor infiltration to MCL-associated glomerulonephritis. Therefore, correct diagnosis with renal biopsy and prospective registries are needed to generate data about differences in outcomes in MCL with various kidney involvement.