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Membranoproliferative glomerulonephritis in association with chronic lymphocytic leukaemia: a report of three cases
Prudence A Hill1, Frank Firkin, Karen M Dwyer
1Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. hillpa@svhm.org.au
Insights
Chronic lymphocytic leukaemia (CLL) can be associated with various types of membranoproliferative glomerulonephritis (MPGN), including a rare case of type III MPGN. Kidney function improved with CLL treatment.
Area of Science:
- Nephrology
- Hematology
- Pathology
Background:
- The association between chronic lymphocytic leukaemia (CLL) and glomerular disease is infrequently reported.
- Investigating renal manifestations in CLL patients is crucial for comprehensive patient care.
Observation:
- Three patients with CLL and glomerulonephritis underwent detailed renal biopsy analysis.
- Utilized light microscopy, immunofluorescence, and electron microscopy for comprehensive evaluation.
Findings:
- Identified diverse membranoproliferative glomerulonephritis (MPGN) types, including type I, fibrillary/immunotactoid, and a novel type III MPGN in CLL patients.
- All cases exhibited monoclonal gammopathy.
- Observed improvement in renal parameters correlating with successful CLL treatment.
Implications:
- Highlights a spectrum of MPGN associated with CLL, emphasizing the role of monoclonal gammopathy.
- This study reports the first instance of type III MPGN in the context of CLL.
- Suggests a potential link between CLL, monoclonal gammopathy, and specific glomerulonephritis subtypes.
Aims:
The reported association of glomerular disease with chronic lymphocytic leukaemia (CLL) is rare despite the relative frequency of this type of leukaemia. Hence, we have examined the renal biopsies in three patients with CLL and glomerulonephritis.
Methods:
Renal biopsies were examined by light microscopy, immunofluorescence microscopy and electron microscopy.
Results:
One of two patients with mild impairment of renal function and an active urinary sediment had ultrastructural features of idiopathic type I membranoproliferative glomerulonephritis (MPGN), and the other had features of fibrillary/ immunotactoid glomerulonephritis with deposits of IgG and C3. One patient with nephrotic syndrome had characteristic electron microscopic appearances of type III MPGN. In all three there was an association with monoclonal gammopathy. The parameters of glomerular damage improved in association with response to drug treatment of the CLL.
Conclusion:
There is a spectrum of types of MPGN seen in patients with CLL and there appears to be an association with the presence of monoclonal gammopathy. This is the first reported case of type III MPGN in CLL.
