V HERON1, S WILKINSON1, P DAVIES1, A YOUNG1, S GOVINDARAJULU1, S VENUTHURUPALLI1
1Renal Service, Darling Downs Hospital And Health Service, Toowoomba, Australia
Background: Lymphoproliferative disorders uncommonly present with glomerulonephritis and acute kidney injury. Very few cases were reported in the literature and the recovery of renal disease is linked to recovery of the lymphoma. Membranoproliferative glomerulonephritis is the most common reported histological lesion especially with cryoglobulinemia.
Case report: A 72-year-old gentleman presented with acute kidney injury (AKI) and haemoproteinuria. He had a background history of carcinoma of prostate in 2009 and of larynx in 2015; both are in remission. On admission his creatinine was 316 µmol/L, with normal renal function a month before (creatinine 70 µmol/L). His renal function worsened during his stay, requiring acute dialysis. Given the finding of AKI with nephritic syndrome he was treated with empirical high dose intravenous methylprednisolone. His vasculitis work-up was negative, however kappa IgM monoclonal paraprotein levels were elevated on serum immunofixation. Serum cryoglobulins were reported positive. Kidney biopsy revealed histological changes consistent with membranoproliferative glomerulonephritis (MPGN) with kappa IgM light chain deposition. The perinephric renal tissue showed lymphocytic infiltration of monoclonal origin. Bone marrow confirmed a B-cell lymphoproliferative disorder. He received a single dose of rituximab as well. During hospitalisation his renal function recovered sufficiently and no longer required ongoing dialysis. He is scheduled for chemotherapy consisting of bendamustine and rituximab.
Conclusions: This is an uncommon case of AKI due to B-cell lymphoproliferative disorder with positive cryoglobulins and histological features consistent with MPGN. Early recognition and diagnosis with appropriate treatment helps in renal recovery as seen in our case. His long-term renal function depends on response to chemotherapy and any future relapses.
Vanessa Heron is an advanced trainee in nephrology currently working at Toowoomba Hospital, Queensland.