Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

Annals of Diagnostic Pathology
Samih H NasrNelson Leung

Abstract

Granulomatous interstitial nephritis (GIN) is an uncommon pathologic lesion encountered in 0.5% to 5.9% of renal biopsies. Drugs, sarcoidosis, and infections are responsible for most cases of GIN. Malignancy is not an established cause of GIN. Here, we report a series of 5 patients with GIN secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Patients were mostly elderly white males with an established history of CLL/SLL who presented with severe renal impairment (median peak serum creatinine, 7.3 mg/dL), leukocyturia, and mild proteinuria. One had nephromegaly. In 2 patients, the development and relapse of renal insufficiency closely paralleled the level of lymphocytosis. Kidney biopsy in all patients showed GIN concomitant with CLL/SLL leukemic interstitial infiltration. Granulomas were nonnecrotizing and epithelioid and were associated with giant cells. One biopsy showed granulomatous arteritis. One patient had a granulomatous reaction in lymph nodes and skin. Steroids with/without CLL/SLL-directed chemotherapy led to partial improvement of kidney function in all patients except 1 who had advanced cortical scarring on biopsy. In conclusion, we report an association between CLL/SLL and GIN. Patients...Continue Reading

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Citations

Nov 9, 2017·Clinical Journal of the American Society of Nephrology : CJASN·Nelson LeungSamih H Nasr
Nov 24, 2017·American Journal of Hematology·David RibesStanislas Faguer
Oct 6, 2018·Clinical Kidney Journal·Rimda WanchooKenar D Jhaveri
Apr 1, 2021·Nature Reviews. Nephrology·Frank BridouxNelson Leung

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