Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia.

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Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic

leukemia.

Eswari Vilayur, Trevillian, and Mark Walsh

Nat Clin Pract Nephrol, November 25, 2008; .

E Vilayur is an Advanced Trainee in Nephrology at Hunter Hospital, P

Trevillian is a Senior Staff Specialist in Nephrology and Transplant Physician

at Hunter Hospital and Deputy Director of the Newcastle Transplant Unit,

and M Walsh is a Senior Hematologist at Calvary Mater Newcastle Hospital and

Hunter Hospital, New Lambton Heights, NSW, Australia.

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.

PMID: 19030000