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Renal involvement in a large cohort of Chinese patients with Castleman disease
Damin Xu1, Jicheng Lv, Yujun Dong
1Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
Insights
Kidney disease is uncommon in Castleman disease (CD). Multicentric CD and specific variants are linked to renal issues, often presenting as thrombotic microangiopathy-like lesions. Chemotherapy effectively treats most kidney damage in CD patients.
Area of Science:
- Nephrology
- Hematology
- Pathology
Background:
- Castleman disease (CD) rarely associates with kidney disease, with limited data from single-case reports.
- This study investigates renal involvement in a large Chinese cohort of CD patients.
Purpose of the Study:
- To describe the clinical and pathological characteristics of renal involvement in Castleman disease.
- To compare findings in a Chinese cohort with existing literature.
Main Methods:
- Retrospective analysis of 76 Castleman disease patients.
- Comparison with a systematic literature review of renal involvement in CD.
Main Results:
- Nineteen patients (25%) had renal involvement, more common in multicentric CD and plasma cell/mixed cellularity variants.
- Proteinuria and acute renal failure were primary presentations; kidney biopsies showed glomerular diseases and thrombotic microangiopathy-like lesions.
- Chemotherapy led to recovery in most cases of acute renal failure, with a low progression rate to end-stage kidney disease.
Conclusions:
- Multicentric Castleman disease and specific histological variants are associated with renal complications.
- Thrombotic microangiopathy-like lesions are the predominant pathological finding.
- Chemotherapy is effective in reversing renal damage in most patients with Castleman disease.
Background:
The association of kidney disease with Castleman disease (CD) is uncommon. To date, most studies have been based on single-case reports. Here, we describe renal involvement in CD in a large Chinese cohort.
Methods:
Seventy-six CD patients were identified in one clinical center. Clinical and pathological characteristics of patients with renal involvement were described, which were also compared with cases identified through a systematic literature review.
Results:
Nineteen patients (25%) exhibited renal involvement. Patients with multicentric clinical type (59 versus 0%) or plasma cell (PC)/mixed cellularity histological variant (61.5 versus 6%) were more likely to have renal involvement (P < 0.001). Proteinuria (with 7/19 reaching nephrotic range) and acute renal failure (12/19, 63%) were the main clinical presentations. Kidney biopsy revealed various glomerular diseases (10/11) and interstitial nephritis (1/11), while with 'thrombotic microangiopathy-like' lesions were the most common pathological characteristics (6/11, 55%). This contrasted significantly with the literature in which amyloidosis was the most reported. Renal outcomes responded well to chemotherapy. Nine (9/12, 75%) patients with acute renal failure recovered completely, one recovered partially. Overall, only three (3/19, 16%) patients progressed to end-stage kidney disease. Renal involvement did not influence survival rate (log-rank test, P = 0.73) in the follow-up.
Conclusions:
CD with multicentric type and PC or mixed cellularity variant are often associated with renal complications. Thrombotic microangiopathy-like lesions are the most common pathological characteristics. Chemotherapy can reverse kidney damage in most cases.