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Abstract: SA-PO230

Successful Obinutuzumab-Based Treatment of Chronic Lymphocytic Leukemia (CLL)-Associated Membranoproliferative Glomerulonephritis (MPGN) Lesion with Kidney Infiltration

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Broka, Andrea, UC Davis Health, Sacramento, California, United States
  • Jen, Kuang-Yu, UC Davis Health, Sacramento, California, United States
  • Wiegley, Nasim, UC Davis Health, Sacramento, California, United States

Chronic lymphocytic leukemia (CLL) is a mature B-cell neoplasm characterized by the accumulation of monoclonal cells in the blood and bone marrow with an indolent course. Extramedullary CLL with kidney involvement is rare, and treatments are based on retrospective studies and expert opinion. We present a patient with CLL-associated kidney involvement and successful complete remission after treatment with an Obinutuzumab-based regimen.

Case Description

A 68-year-old White man with CLL, chronic kidney disease and heart failure who presented with worsening edema and kidney function on outpatient labs. Workup showed creatinine (Cr) of 4.4 mg/dL (baseline 1.4) with urine protein/creatinine ratio >5g/g, white blood cell count of 83 x109/L (baseline) (Fig 1). Complement C3 was low, and Hepatitis panel, HIV, Rheumatoid factor, cryoglobulin, and C4 were negative. Kidney biopsy showed a membranoproliferative glomerulonephritis pattern of injury with cellular crescents, possible cryoglobulins, and focal involvement by CLL cells (Fig 2). Obinutuzumab-based therapy in combination with steroids, cyclophosphamide, and vincristine resulted in an improvement of kidney function and complete remission of nephrotic syndrome and CLL.


CLL-associated MPGN pattern of injury with cryoglobulinemia and leukemic cell infiltration of the kidneys is a rare complication of CLL, more common in White elderly men compared to others. Previously, chemotherapy with rituximab plus other agents was the standard of care. However, Obinutuzumab has shown better efficacy compared to rituximab in patients with untreated CLL. Obinutuzumab is a second-generation anti-CD20 monoclonal Ab with enhanced antibody-dependent cellular cytotoxicity and superior progression-free survival. Detection of proteinuria or declining kidney function in patients with CLL should trigger evaluation and consideration of kidney biopsy. Prompt treatment with Obinutuzumab regimen can result in kidney recovery and improved patient outcomes.