Kidney Damage in the Manifestation of Lymphoproliferative Diseases

Objectives:

Kidney lesions at lymphoproliferative diseases mainly described with disease progression or relapse. Renal involvement in the manifestation of lymphoproliferative diseases were observed rarely. Pathogenesis of renal damage is obscure.

Aim: To determine especially renal damage in the manifestation of lymphoproliferative diseases.

Subjects and methods. The study included 19 patients (13 males, and 6 females, age 63.3±8.8 years) with lymphoproliferative diseases accompanied by renal failure: chronic lymphocytic leukemia (n=12), marginal zone lymphoma (n=4), follicular lymphoma (n=1), Waldenstrom's macroglobulinemia (n=1), diffuse large B-cell lymphoma (n=1). Nephrotic syndrome was observed in 3 patients and renal failure in 18 ones. The average creatinine level was 330.9±152.3 μmol/l, glomerular filtration rate was 25.7±12.9 ml/min. The presence of monoclonal IgMk secretion (n=6), Bence Jones protein kappa (n=9), increased level of free light chains (n=4), cryoglobulin (n=4). The renal biopsy was studied by histological, immunohistochemical, immunofluorescence, and electron microscopy.

Results:Glomerulonephritises were revealed in 10 cases (52.6%): membranoproliferative glomerulonephritis (n=2), membranous (n=2), mesangiocapillary (n=3), fibrillary (n=1), immunotactoid glomerulonephritis (n=1), minimal-change disease (n=1). Neoplastic lymphoid infiltration of renal parenchyma was detected in 10 (52.6%) cases. The massive diffuse small cell lymphoid proliferation was determined in 1 case, focal infiltration in 9 ones. Neoplastic lymphoid infiltration was associated with glomerulonephritis in 3 cases and with carcinoma of the kidney in 4 cases. Large focal lymphoid proliferation was found in 1 case in a patient with diffuse large B-cell lymphoma. AL - amyloidosis was identified in 2 cases and the thrombotic microangiopathies in 2 ones.

Conclusion. Glomerular disease, lymphoid tumor infiltration, sometimes AL - amyloidosis, thrombotic microangiopathy were detected in the manifestation of lymphatic tumor. In all cases examined, there was a secretion of monoclonal immunoglobulin, protein Bence Jones, free light chains and cryoglobulin, pathogenetic value in the development of glomerulopathy should be clarified.