J YAU1, D HSU2, J YONG3, J MAI1
1Department of Nephrology, Sydney South West Area Health Service, Sydney, Australia, 2Department of Haematology, Sydney South West Area Health Service, Sydney, Australia, 3Department of Anatomic Pathology, Sydney South West Area Health Service, Sydney, Australia
Background: Chronic lymphocytic leukaemia (CLL) is a neoplasm of mature B cells which is often observed without treatment in its early stages. Renal infiltration has been described in 63–90% of all CLL patients who underwent autopsy. Renal failure caused by direct organ infiltration as described in this case is rare.
Case Report: We present a 61-year-old Caucasian male with stable untreated stage A CLL with progressive renal impairment. The serum creatinine increased from a baseline of 80 µmol/L to 356 µmol/L over six months. His only symptom was malaise and the medical history limited to previously treated Hepatitis C. The full blood count parameters were ostensibly stable with a lymphocytosis of 94.9 x 10⁹/L, haemoglobin 92 g/L and platelet count 170 x 10⁹/L; all of which had not changed significantly since the onset of renal failure. There was no palpable lymphadenopathy, splenomegaly, nor any weight loss, fevers or night sweats. Renal ultrasound showed normal kidney size without obstruction. Serology for the vasculitides and viral hepatitis was unremarkable. Renal biopsy demonstrated extensive interstitial infiltration by atypical mononuclear lymphoid cells with preserved glomeruli and intact tubular architecture. The lymphoid cells expressed CD20, Bcl-2, and CD23 but was negative for CD5. The patient commenced chemotherapy for CLL with ofatumumab and chlorambucil. The treatment was well tolerated. The serum creatinine improved rapidly and approached baseline levels after three months.
Conclusions: Acute renal impairment secondary to lymphomatous renal infiltration is a rare manifestation of lymphoproliferative disease which may not be suspected or detected upon routine haematological monitoring. In this case chemotherapy was well tolerated and effective with prompt renal improvement.
Dr Jerson Yau MBBS BMedSci
Dr Jerson Yau studied medicine at the University of Sydney and is completed his Internship training at Nepean Hospital, and is currently a Resident in-training.Dr Yau has a strong interest in Nephrology and its pathophysiologies and treatment outcomes, particularly acute kidney injury and glomerulonephritis. He was the first medical student to present at Renal Medical Grand Rounds at Nepean Hospital, a case on acute kidney injury and analgesic nephropathy.