Abstract: FR-PO1269
A Case of Granulomatous Interstitial Nephritis Due to Chronic Lymphocytic Leukemia
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
- Thomopulos, Alexander, Emory University School of Medicine, Atlanta, Georgia, United States
- Gillman, Nicole, Emory University School of Medicine, Atlanta, Georgia, United States
- Suarez, Jonathan J., Emory University School of Medicine, Atlanta, Georgia, United States
- Shackelford, Rondey E., Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Granulomatous interstitial nephritis (GIN) is a distinct morphological variant of interstitial nephritis and a rare finding in renal biopsies. It is typically associated with antibiotics, NSAIDs, infections, and granulomatous disorders. We present a case of GIN secondary to chronic lymphocytic leukemia (CLL).
Case Description
A 75 year old female with a history of seronegative RA, HTN, HLD, CKD stage 3 and CLL (under active surveillance) presented with progressive dyspnea on exertion and functional decline. Patient had been followed closely by hematology and had not required any treatment. On presentation, creatinine was 4.04 mg/dL (baseline Cr ~1) and WBC of 54.8k. Urinalysis had 9/HPF RBCs, 12/HPF WBCs and Leukocyte Esterase. Urine culture was negative. UPCR was 0.27 g/g. Renal Ultrasound was negative for hydronephrosis. CT chest/abdomen/pelvis were notable for diffuse lymphadenopathy. Granular casts were noted on urine sediment; AKI suspected to be secondary to ATN. However, Cr continued to rise, peaking at 9.76 mg/dL. Patient underwent a renal biopsy which showed GIN secondary to CLL.
Discussion
GIN is only detected in 0.5-0.9% of all renal biopsies. It is commonly linked to antibiotics, NSAIDs, sarcoidosis, tuberculosis, fungal infections, and GPA. Patients usually have mild proteinuria, normal blood pressure, and less frequently have sterile pyuria and microscopic hematuria. Although leukemic infiltration of the kidneys is common, it does not present with kidney dysfunction. GIN secondary to CLL, comparatively, is uncommon and renal biopsy is critical to diagnosis. Biopsy findings in GIN are defined as interstitial inflammation and granulomas. The granulomas are non-necrotizing and epithelioid and can be associated with giant cells. It is hypothesized that such granulomas form through the T-cell-mediated immunological response against tumor cell-derived soluble antigens. Treatment for our patient included steroids and Zanubrutinib, which improved her renal function.