Membranoproliferative glomerulonephritis and light-chain nephropathy in association with chronic lymphocytic leukemia.

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Membranoproliferative glomerulonephritis and light-chain nephropathy in

association with chronic lymphocytic leukemia.

R Mutluay, S Zeynep Aki, Y Erten, C Konca, M Yagci, G Barit, and S Sindel

Clin Nephrol, December 1, 2008; 70(6): 527-31.

1Department of Nephrology, 2Department of Hematology, 3Department of Internal

Medicine, and 4Department of Pathology, Faculty of Medicine, Gazi University,

Besevler Ankara, Turkey.

The incidence of nephrotic syndrome co-existing with chronic lymphocytic

leukemia (CLL) is a rare condition. Almost any glomerular pathology may

accompany CLL. The most frequent of all is membranoproliferative

glomerulonephritis (MPGN). Moreover, in 5 - 10% of patients with CLL, monoclonal

gammopathy may be detected in serum and/or urine samples. There are no

well-established treatment protocols for those CLL patients with accompanying

nephrotic syndrome. In this case report, we present a 55-year-old female patient

diagnosed with CLL, developing nephrotic syndrome, renal dysfunction and IgG

k-type monoclonal gammopathy in the follow-up. The renal biopsy revealed

glomerular and tubular deposits of k-chain and histopathology of

membranoproliferative glomerulonephritis. Rituximab along with CVP

(cyclophosphamide - vincristine - prednisolone) chemotherapy regimen was

initiated. At the end of 6 courses of treatment, the patient was on

" nephrologic " partial remission as the serum creatinine and albumin levels had

returned to normal and proteinuria decreased by more than 50%. The patient was

also in partial remission for CLL. In conclusion, in patients with CLL and

nephrotic syndrome, presence of MPGN along with light-chain nephropathy is

rarely reported. Several different treatment protocols are discussed for these

patients. Among these regimes, R-CVP is an acceptable alternative for CLL

patients with MPGN.

PMID: 19049712