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Kidney Week

Abstract: PO2203

Attack of the Clones: Leukemia and Myeloma

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

  • Wong, Sara, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Patel, Shreya, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Alaimo, Elizabeth A., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Azad, Shanaz, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Jain, Pankaj, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Sarguroh, Tauseef A., Franciscan Health Inc, Mishawaka, Indiana, United States
Introduction

Chronic lymphocytic leukemia(CLL) and multiple myeloma(MM) are both neoplastic diseases that are monoclonal tumors of differentiated B-cells that rarely occur simultaneously. There is disagreement and conflicting evidence as to whether these seemingly distinct disorders may arise from identical clones. In some cases MM maybe diagnosed up to 15 years after the established diagnosis of CLL. We describe a rare case of a patient with renal failure and nephrotic range proteinuria where both CLL and MM were diagnosed concomitantly from a single renal biopsy.

Case Description

59 y/o Indian male with COPD, DM-type 2, HTN, recent pseudomonas aeruginosa pneumonia presented with bilateral temporal headaches and fevers. Work-up revealed creatitine: 1.7mg/dl, UPCR: 6.6 g/g, free kappa/lambda ratio of 0.25 and mildly depressed C3 and C4. Renal biopsy showed diffuse proliferative and crescentic g/omerulonephritis with IgG lambda light chain restriction, CD-20 positive lymphocytic interstitial infiltrate, ATN and diabetic glomerulopathy. EM also revelaed subepithelial hump-shaped depositis and abundant glomerular neutrophils suggesting a component of post-infectious GN. Both flow cytomtery and bone marrow biopsy revealed monotypic B-lymphocyte population with aberrant expression of CD5 and CD23 consistent with the diagnosis of CLL. The patient was treated with cyclophosphamide and dexamethasone and is currently stable on Ibrutinib with a creatinine of 1.3mg/dl.

Discussion

CLL is a common hematologic malignancy that has many systemic complications. Autopsies have shown that 90% of CLL pateints have renal infiltration; however there is seldom renal impairment. This is a rare case of renal CLL infiltration causing type-1 cryoglobulinemia with IgG lambda monocolonal gammopathy of renal significance. Early diagnosis with renal and bone marrow biopsy and subsequent treatment with immunosuppresive therapy is crucial.

CD20 positive lymphocytic renal interstitial infiltrate.