Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience

Abstract

While the renal complications of plasma cell dyscrasia are well-described, most information in patients with chronic lymphocytic leukemia and monoclonal B lymphocytosis is derived from case reports. This is a retrospective analysis of patients with chronic lymphocytic leukemia or monoclonal B lymphocytosis who underwent a kidney biopsy for renal insufficiency and/or nephrotic syndrome. Between 01/1995 and 06/2014, 49 of 4024 (1.2%) patients with chronic lymphocytic leukemia (44) or monoclonal B lymphocytosis (5) had a renal biopsy: 34 (69%) for renal insufficiency and 15 (31%) for nephrotic syndrome. The most common findings on biopsy were: membranoproliferative glomerulonephritis (n=10, 20%), chronic lymphocytic leukemia interstitial infiltration as primary etiology (n=6, 12%), thrombotic microangiopathy (n=6, 12%), and minimal change disease (n=5, 10%). All 5 membranoproliferative glomerulonephritis patients treated with rituximab, cyclophosphamide and prednisone based regimens had recovery of renal function compared to 0/3 patients treated with rituximab +/- steroids. Chronic lymphocytic leukemia infiltration as the primary cause of renal abnormalities was typically observed in relapsed/refractory patients (4/ 6). Thrombotic microangiopathy primarily occurred as a treatment related toxicity due to pentostatin (4/6 cases), and resolved with drug discontinuation. All cases of minimal change disease resolved with immunosuppressive agents only. Renal biopsy plays an important role in the management of patients with chronic lymphocytic leukemia or monoclonal B lymphocytosis who develop renal failure and/or nephrotic syndrome.