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Abstract: PO1813

C3 Glomerulonephritis: A Rare Complication of Chronic Lymphocytic Leukemia

Session Information

Category: Trainee Case Report

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Srour, Khaled, Henry Ford Hospital, Detroit, Michigan, United States
  • Lakshmikanth, Jayanth, Henry Ford Hospital, Detroit, Michigan, United States
  • Chitturi, Chandrika, Henry Ford Hospital, Detroit, Michigan, United States
  • Faber, Mark D., Henry Ford Hospital, Detroit, Michigan, United States
Introduction

Kidney disease develops in chronic lymphocytic leukemia (CLL) patients via multiple mechanisms including infiltration, obstruction, tumor lysis syndrome, and glomerular disease. We present a rare case of C3 glomerulonephritis (C3GN) associated with pulmonary renal syndrome that we believe was an autoimmune manifestation of CLL.

Case Description

A 76 year old male with a 15 year history of SLL/CLL, DVT, HTN, DM and Stage 3 CKD developed SOB and dry cough. At ED presentation he was in respiratory distress with BIPAP resistant hypoxia requiring intubation. Labs included Cr 7.1 mg/dL, K 5.7 mEq/L and uric acid 12.2 mg/dL CXR showed vascular congestion. Prior to developing anuria urine sediment showed RBC casts.
Bronchoscopy DAH, consistent with a pulmonary renal syndrome. Patient was started on plasmapheresis, high dose steroids and CRRT. Autoimmune workup including ANA, anti GBM and ANCA was negative.
Kidney biopsy showed diffuse proliferative and sclerosing glomerulonephritis with lymphocytic infiltrates consistent with involvement by patient's known CD5+, CD23+ B cell lymphoproliferative disorder. IF showed diffuse C3 staining. Steroids and plasmapheresis were continued. Renal function improved and dialysis discontinued, with Cr at last follow up 1.9. Chemotherapy for CLL has been ordered. Lymphocytes were negative for CD3, CD10, Bcl6, and cyclin D1; with a MIB1 nuclear proliferation rate within the lymphoid infiltrates less than 5%.

Discussion

We present a case of C3GN and DAH secondary to CLL autoimmune etiology, a rare complication of CLL which usually affects the kidney by infiltration and by toxicity of the CLL treatment. Recent case reports suggest improved outcomes of CLL associated C3GN when CLL is treated.