Clinical and Presentation and Pathology Spectrum of Kidney Damage in Non-Hodgkin Lymphoma/Leukemia and Lymphoplasmacytic Lymphomas

Kidney damage in non-Hodgkin lymphoma/leukemia (NHL/CLL) and lymphoplasmacytic lymphomas
(LPCL) are caused by several mechanisms: tumor mass localization; clonal cell expansion;
hormones, cytokines and growth factors secretion; metabolic, electrolyte and coagulation
disturbances; deposition of paraproteins and treatment complications. Symptoms of kidney damage
may dominate and even preclude overt NHL/CLL or LPCL, and only renal pathology findings give the
clue to the diagnosis. We aimed to evaluate clinical presentation and pathology of kidney damage in
patients with NHL/CLL or LPCL. Using electronic database and purposely designed chart, we
searched data for 158 patients with lymphoproliferative disorders (LPD) and pathology proven kidney
lesions. Patients with multiple myeloma, Hodgkin’s lymphoma, Castleman disease, “primary” AL
amyloidosis and “primary” light chain deposition disease were excluded from further analysis. Study
group consisted of 24 patients, 14 (58.3%) male and 10 (41.7%) female, median age 67 [17,76] years.
16 patients (66.6%) were diagnosed with NHL/CLL, 7 patients (29.1%) with Waldenström’s
Macroglobulinemia (WM) and 1 (4.1%) with Franklin’s disease (FD). 10 (41.7%) of patients presented
with nephrotic syndrome (NS), 17 (70.8%) – with impaired kidney function, and 6 (25.2%) with both
NS and renal dysfunction. By pathology glomerulonephritis (GN) was found in 11 (45.8%) of patients,
in 4 cases GN pattern was associated with monoclonal paraproteins, and in 7 cases GN was
considered to be paraneoplastic. Interstitial nephritis was seen in 10 (41.6%) patients, in 8 of them
due to specific lymphoid infiltration; and amyloidosis complicated only 3 (12.5%) cases. Patients with
NHL/CLL or LPCL, presenting with renal abnormalities, show variety of pathology patterns hardly
predictable on clinical basis. Most often in our patient series was specific lymphoid interstitial
infiltration and paraneoplastic glomerulonephritis with MN and MPGN patterns. In many cases of NS
and/or acute kidney injury (AKI) renal biopsy was crucial for the diagnosis of NHL/CLL and LPCL. Our
retrospective single-center study of 24 patients with pathology-proven kidney damage showed, that
patients with non-Hodgkin lymphomas and lymphoplasmacytic lymphomas, presenting with renal
abnormalities, show variety of pathology patterns, hardly predictable on clinical basis. Most often in
our patient series turned to be specific lymphoid interstitial infiltration and paraneoplastic
glomerulonephritis with MN and MPGN patterns. In many cases of nephrotic syndrome and/or acute
kidney injury, renal biopsy, precluded or followed by scrutinous hematological work-up is crucial for
the diagnosis of NHL/CLL and LPCL.