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Kidney failure in a patient with chronic B-lymphocytic leukaemia (B-CLL) with underlying cast nephropathy. The value of free immuno­globulin light chain identification for early diagnosis of this complication


Authors: Z. Adam 1;  S. Štěpánková 2;  A. Sirotková 3;  Z. Čermáková 4;  L. Pour 1;  M. Krejčí 1;  L. Zahradová 1;  Z. Kořístek 1;  J. Lenz 3;  R. Hájek 1;  J. Vorlíček 1;  J. Mayer 1
Authors‘ workplace: Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Mayer, CSc. 1;  Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. 2;  I. patologicko-anatomický ústav Lékařské fakulty MU a FN u sv. Anny Brno, přednostka prof. MUDr. Markéta Hermanová, Ph. D. 3;  Oddělení klinické biochemie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc. 4
Published in: Vnitř Lék 2011; 57(2): 214-221
Category: Case Reports

Overview

We describe a case of an untreated female patient monitored over 8 years for chronic B-lymphocytic leukaemia (B-CLL). Over the 8 years, the patient has gradually developed severe kidney failure, even though the criteria for B-CLL treatment had not been fulfilled. Kidney biopsy revealed renal damage due to λ free light chains cast nephropathy as well as an infiltration of renal parenchyma with B-CLL cells. It was not before this biopsy that the presence of monoclonal immunoglobulins has been investigated. Immunofixation identified free monoclonal λ light chains in the serum and urine. Their serum concentration, quantified by densitometry, was 2.6 g/ l and urine concentration was 0.5 g/ l. A specific evaluation of free light chains in the serum revealed an extremely high concentration of free λ light chains, over 4,500 mg/ l, and normal concentration of κ free light chains, 10 mg/ l. The aim of this report is to emphasise that monoclonal immunoglobulin may be present in B-CLL as well as other lymphoprolipherative diseases and that it may cause damage to organs, similar to multiple myeloma or monoclonal gammopathy of undetermined significance. The described case confirms poor prognostic value of monoclonal immunoglobulin free light chains in patients with B-CLL and usefulness of an evaluation of their presence in patients with B-CLL, particularly if the patients have increased creatinine level. The described case also highlights the need for evaluation of the presence of free light chains in the serum of all patients with unclear cause of renal failure.

Key words:
cast nephropathy – monoclonal gammopathy – multiple myeloma – chronic B-lymphocytic leukemia – electrophoresis with immunofixation – light chain of immunoglobulin – renal failure


Sources

1. Krejčí M, Adam Z, Pour L et al. Chronická B-lymfatická leukemie a jí podobné stavy. Vnitř Lék 2009; 55: 746–766.

2. Mayer J, Doubek M, Brychtová Y et al. Využití rituximabu v léčbě chronické lymfatické leukemie. Klin Onkol 2003; 16: 178–183.

3. Panovská A, Doubek M, Brychtová Y et al. Chronic lymphocytic leukemia and focusing on epidemiology and management in everyday hematologic practice: recent data from the Czech Leukemia Study Group for Life (CELL). Clin Lymphoma Myeloma Leuk 2010; 10: 297–300.

4. Papajík T, Jarošová M, Pikalová Z et al. Chronická B-lymfocytární leukemie. Část II. Diagnostická kritéria a význam stanovení individuální prognózy nemocného. Transfuze Hematol Dnes 2006; 12: 132–139.

5. Papajík T, Jarošová M, Plachý R et al. Chronická B-lymfocytární leukemie. Část I. Pohled na původ, biologii a genetické změny leukemických buněk. Transfuze Hematol Dnes 2006; 12: 53–61.

6. Papajík T, Urbanová R, Kubová Z et al. Chronická B-lymfocytární leukemie. Část IV. Možnosti léčby s použitím monoklonálních protilátek alemtuzumabu a rituximabu. Transfuze Hematol Dnes 2007; 13: 48–55.

7. Papajík T, Urbanová R, Procházka V et al. Chronická B-lymfocytární leukemie. Část III. Současné konvenční možnosti primární léčby. Transfuze Hematol Dnes 2006; 12: 249–256.

8. Kořístek Z. Trombotické mikroangiopatie. In: Penka M, Buliková A et al (eds). Neonkologická hematologie. Praha: Grada Publishing 2009.

9. Adam Z, Tomíška M, Krejčí M et al. Diferenciální diagnostika eozinofilie. Vnitř Lék 2009; 55 (Suppl 1): S125–S144.

10. Adam Z, Pour L, Krejčí M et al. Poškození ledvin při mnohočetném myelomu a dalších monoklonálních gamapatiích. Vnitř Lék 2008; 54: 847–861.

11. Adam Z, Krejčí M, Tichý M et al. Léčba selhání ledvin u mnohočetného myelomu. Vnitř Lék 2009; 55: 570–582.

12. Adam Z, Nedbálková M, Krejčí M et al. Více než 10 let trvající kompletní remise monoklonální gamapatie nejistého významu a vymizení nefrotického syndromu vzniklého na podkladně light chain depositon disease po léčbě vinkristinem, adriamycinem a vysokými dávkami dexametazu (VAD). Vnitř Lék 2010; 56: 240–247.

13. Noel P, Kyle RA. Monoclonal proteins in chronic lymphocytic leukemia. Am J Clin Pathol 1987; 87: 385–388.

14. Pezzoli A, Pascali E. Monoclonal Bence Jones proteinuria in chronic lymphocytic leukaemia. Scand J Haematol 1986; 36: 18–24.

15. Deegan MJ, Abraham JP, Sawdyk M et al. High incidence of monoclonal proteins in the serum and urine of chronic lymphocytic leukemia patients. Blood 1984; 64: 1207–1211.

16. Yegin ZA, Ozkurt ZN, Yağci M. Free light chain: a novel predictor of adverse outcome in chronic lymphocytic leukemia. Eur J Haematol 2010; 84: 406–411.

17. Pratt G, Harding S, Holder R et al. Abnormal serum free light chain ratios are associated with poor survival and may reflect biological subgroups in patients with chronic lymphocytic leukaemia. Br J Haematol 2009; 144: 217–222.

18. Martin W, Abraham R, Shanafelt T et al. Serum-free light chain-a new biomarker for patients with B-cell non-Hodgkin lymphoma and chronic lymphocytic leukemia. Transl Res 2007; 149: 231–235.

19. Bakshi NA, Gulbranson R, Garstka D et al. Serum free light chain (FLC) measurement can aid capillary zone electrophoresis in detecting subtle FLC-producing M proteins. Am J Clin Pathol 2005; 124: 214–218.

20. Aktan M, Akkaya A, Doğan O et al. Chronic lymphocytic leukemia and multiple myeloma in the same patient: case report. Leuk Lymphoma 2003; 44: 1421–1424.

21. Preud’homme JL, Bauwens M, Dumont G et al. Cast nephropathy in mu heavy chain disease. Clin Nephrol 1997; 48: 118–121.

22. Al-Jehani F, Alsousou J, Gover P. Nephrotic syndrome associated with chronic lymphocytic leukaemia. Hematology 2004; 9: 401–403.

23. Comerma-Coma MI, Sans-Boix A, Tuset-Andújar E et al. Reversible renal failure due to specific infiltration of the kidney in chronic lymphocytic leukaemia. Nephrol Dial Transplant 1998; 13: 1550–1552.

24. Erten N, Saka B, Caliskan YK et al. Acute renal failure due to leukaemic infiltration in chronic lymphocytic leukaemia: case report. Int J Clin Pract Suppl 2005; 147: 53–55.

25. Ferreira AC, Brum S, Carvalho D et al. Renal dysfunction due to leukemic infiltration of kidneys in a case of chronic lymphocytic leukemia. Hemodial Int 2010; 14: 87–90.

26. Hadj-Moussa M, Brown JA. Reversible renal insufficiency secondary to extrinsic splenic compression of the kidney in a patient with chronic lymphocytic leukemia. Scientific World Journal 2010; 10: 796–798.

27. Hewamana S, Pepper C, Jenkins C et al. Acute renal failure as the presenting feature of leukaemic infiltration in chronic lymphocytic leukaemia. Clin Exp Nephrol 2009; 13: 179–181.

28. Kamat AV, Goldsmith D, O’Donnell P et al. Renal failure with granulomatous interstitial nephritis and diffuse leukemic renal infiltration in chronic lymphocytic leukemia. Ren Fail 2007; 29: 763–765.

29. Kiewe P, Tepel M, Loddenkemper C et al. Extensive leukemic kidney infiltration with membranoproliferative glomerulonephritis in a patient with B-cell chronic lymphocytic leukemia. Ann Hematol 2007; 86: 691–692.

30. Lentaigne C, Craig C, Cwynarski K et al. Chronic lymphocytic leukemia can cause acute renal failure even in early stage patients. Leuk Lymphoma 2010; 51: 333–334.

31. Martinez-Vea A, Herranz MJ, Llorente A et al. Acute renal failure with chronic lymphocytic leukaemia. Postgrad Med J 1996; 72: 763–765.

32. Nasr SH, Snyder RW, Bhagat G et al. Chronic lymphocytic leukemia and cryoglobulinemic glomerulonephritis. Kidney Int 2007; 71: 93.

33. Rockx MA, Rizkalla K, Clark WF. Acute renal failure and chronic lymphocytic leukaemia. Nephrol Dial Transplant 2008; 23: 770–771.

34. Rosado MF, Morgensztern D, Abdullah S et al. Chronic lymphocytic leukemia-associated nephrotic syndrome caused by focal segmental glomerulosclerosis. Am J Hematol 2004; 77: 205–206.

35. Vilayur E, Trevillian P, Walsh M. Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia. Nat Clin Pract Nephrol 2009; 5: 54–58.

36. Da’as N, Polliack A, Cohen Y et al. Kidney involvement and renal manifestations in non-Hodgkin’s lymphoma and lymphocytic leukemia: a retrospective study in 700 patients. Eur J Haematol 2001; 67: 158–164.

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