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Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia

Nature Clinical Practice Nephrology volume 5, pages 54–58 (2009)Cite this article

Abstract

Background A 42-year-old previously healthy man was referred to hospital with an 8-week history of fevers, night sweats, fatigue, and unintentional weight loss. There was no past history of medical illness or any medication use. Physical examination was unremarkable. On urinalysis, the patient had hematuria (grade 4+) and proteinuria (grade 4+).

Investigations Urine phase-contrast microscopy, full blood count, renal function tests, 24-h urine collection for protein, serum immune electrophoresis, renal biopsies, phase-contrast microscopy, serological tests for antinuclear antibodies, extractable nuclear antigens, antineutrophil cytoplasmic antibodies, hepatitis B, hepatitis C and HIV, cryoglobulin test, complement testing, flow cytometry of the peripheral blood, and bone marrow biopsy.

Diagnosis Monoclonal gammopathy and a glomerulopathy, with microtubular deposits, associated with chronic lymphocytic leukemia.

Management Treatment with prednisone and cyclophosphamide did not improve proteinuria, although lymphocyte count returned to normal. The patient did not tolerate high-dose cyclophosphamide and was started on rituximab. His proteinuria completely resolved and there was complete disappearance of the microtubules.

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Figure 1: Graphs showing the changes in (A) proteinuria and (B) serum creatinine levels with treatment.
Figure 2: High-power views of the renal biopsy specimen with light microscopy using hematoxylin and eosin staining.
Figure 3: Electron microscopic pictures of the patient's initial renal biopsy.
Figure 4: Pictures of the patient's third renal biopsy, 14 months after the first biopsy and 8 weeks after completion of rituximab treatment.

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Acknowledgements

The authors would like to thank Mark Formby, Hunter Area Pathology Service, for all the histopathology figures provided in this Case Study.

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Authors and Affiliations

  1. E Vilayur is an Advanced Trainee in Nephrology at John Hunter Hospital, P Trevillian is a Senior Staff Specialist in Nephrology and Transplant Physician at John Hunter Hospital and Deputy Director of the Newcastle Transplant Unit, and M Walsh is a Senior Hematologist at Calvary Mater Newcastle Hospital and John Hunter Hospital, New Lambton Heights, NSW, Australia.,

    Eswari Vilayur, Paul Trevillian & Mark Walsh

Authors
  1. Eswari Vilayur
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  2. Paul Trevillian
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  3. Mark Walsh
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Correspondence to Eswari Vilayur.

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The authors declare no competing financial interests.

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Vilayur, E., Trevillian, P. & Walsh, M. Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia. Nat Rev Nephrol 5, 54–58 (2009). https://doi.org/10.1038/ncpneph0989

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