Abstract: TH-PO1151
Monoclonal Membranous Nephropathy as the Initial Manifestation of Chronic Lymphocytic Leukemia
Session Information
- Onconephrology: Emerging Biomarkers, Preclinical Models, Clinical Challenges, and Therapeutic Strategies
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Reed, Hunter T., University of South Florida, Tampa, Florida, United States
- Audi, Akram, University of South Florida, Tampa, Florida, United States
Introduction
Paraneoplastic glomerular disease is a rare and very important entity in onco-nephrology, since it can be the initial manifestation of an underlying malignancy. True incidence is likely underestimated due to under-screening and subclinical disease. Definitive therapy targets the underlying malignancy.
Case Description
A 76 yo male with medical history of hypertension on lisinopril and nephrolithiasis, developed foamy urine and was diagnosed with nephrotic syndrome that prompted referral to nephrology clinic. A 24 hour urine collection showed 10.5g proteinuria and serum albumin was 2.8 g/dL. SPEP showed M spike at 0.1 g/dL, serum IFE showed IgG Kappa monoclonal protein. A kidney biopsy was performed in October 2025 and revealed “monoclonal membranous glomerulopathy with IgG1 kappa restricted and 10-20% interstitial fibrosis and tubular atrophy”. Subsequently, a bone marrow biopsy was done in November 2025 and was consistent with chronic lymphocytic leukemia (CLL). The patient received 2 cycles of 4 doses each of IV rituximab (total of 8 doses of IV rituximab) between December 2025 and February 2026. Furthermore, he was started on oral prednisone taper with starting dose of 40 mg daily, for its lymphodepleting effect. A repeat 24hr urine collection in April 2026 showed significant improvement with 1.7g proteinuria. Renal function remained stable and serum albumin increased to 3.7 g/dL.
Discussion
Paraneoplastic membranous nephropathy (MN) is more commonly associated with solid tumors, such as lung and prostate cancer. MN secondary to hematological malignancy is uncommon, seen more often in CLL and Non-Hodgkin Lymphoma, and has good response to treatment of the underlying malignancy. In our case, the pathophysiology of renal injury was mediated by monoclonal immunoglobulin toxicity, originating from the underlying CLL. It is of utmost importance to know that paraneoplastic glomerulopathy may precede cancer diagnosis, and treating the malignancy is the cornerstone of therapy.