Abstract: FR-PO1256
Isolated Kidney Involvement as the Initial Manifestation of Recurrent Mantle-Cell Lymphoma
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Wiscombe, Christian J., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Jain, Koyal, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Saha, Manish K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Introduction
Mantle cell lymphoma is a rare generally aggressive B-cell non-Hodgkins's lymphoma with a 5-year relative survival rate of approximately 50-55%. Primary diagnosis is made through a lymph node biopsy, although in rare cases renal biopsy may be diagnostic. Early detection of recurrence is crucial to improve mortality.
Case Description
We present a case of a 72-year-old man with past medical history of mantle cell lymphoma in remission for 10 years who presented to the hospital with acute kidney injury. His serum creatinine peaked at 3.2 mg/dL from a baseline of 1.2 mg/dL. He also had newly discovered 10 g of proteinuria. His infectious and immunologic workup was negative apart from slightly decreased C3 and C4 levels in addition to mildly elevated rheumatoid factor level. He underwent renal biopsy which revealed diffuse proliferative glomerulonephritis with 20% cellular crescents. Multiple foci of lymphoid aggregates were detected in 30% of the renal parenchyma with a patchy distribution. Immunofluorescence revealed mesangial and capillary wall staining for full house pattern. Multiple foci with aggregates of small lymphoid cells showed positive staining with IgM and kappa light chain restriction which was consistent with mantle cell lymphoma. The Ki-67 proliferation index was low ranging from 10-20% (measure of actively dividing tumor cells). Electron microscopy demonstrated extensive foot process effacement of podocytes affecting 70-80% of the basement membrane surface area. It also showed numerous mesangial and subendothelial deposits. Thus, the patient was diagnosed with immune complex glomerulonephritis secondary to mantle cell lymphoma. He was treated with corticosteroids, Bendamustine (Alkylating agent), and rituximab (B-cell depleting agent) therapy targeting the mantle cell lymphoma with marked improvement of his creatinine back to baseline and resolution of his proteinuria.
Discussion
Mantle cell lymphoma can involve the kidneys by direct infiltration or result in an immune complex glomerulonephritis. Patients presenting with acute kidney injury with history of mantle cell lymphoma should have low threshold for biopsy. Early detection and management can prevent progressive kidney disease.