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[Minimal-change glomerulonephritis in chronic lymphocytic leukemia: A clinical case]
B T Dzhumabaeva1, L S Biryukova1, E P Golitsyna2
1Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
Insights
This case study shows successful treatment of chronic lymphocytic leukemia (CLL) with minimal-change glomerulonephritis (GN) and kidney failure using rituximab and bendamustine. The combination therapy achieved complete remission and restored kidney function.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) can present with kidney complications like glomerulonephritis (GN).
- Minimal-change GN with nephrotic syndrome and renal failure poses therapeutic challenges in CLL patients.
Observation:
- A 64-year-old female with advanced Binet stage C CLL developed minimal-change GN, nephrotic syndrome, and acute renal failure.
- Diagnosis of GN was confirmed via electron microscopy of renal biopsy samples.
Findings:
- Treatment with rituximab and bendamustine resulted in complete CLL remission after five cycles.
- The patient experienced complete resolution of nephrotic syndrome and full recovery of kidney function during a 20-month follow-up.
Implications:
- Combination therapy with rituximab and bendamustine is effective for managing CLL with concurrent GN and renal failure.
- This approach offers a potential treatment strategy for similar complex cases, improving patient outcomes.
- Successful management highlights the importance of addressing both hematologic and renal aspects in co-occurring conditions.
Abstract:
Chronic lymphocytic leukemia (CLL) in association with glomerulonephritis (GN) and renal failure is a serious problem in terms of therapy. The paper reports a clinical case of a 64-year-old female patient with Binet stage C CLL accompanied by minimal-change GN complicated by nephrotic syndrome and the development of acute renal failure. GN was diagnosed on the basis of electron microscopic studies of renal biopsy specimens. It was treated with rituximab in combination with bendamustine. The former was intravenously injected in a dose of 375 mg/m2 on day 0 of the cycle; the latter was given in a dose of 70 mg/m2 within the first 2 days; the cycle was repeated 28 days after initiation of the previous cycle. Five cycles could result in complete CLL remission (the follow-up duration was 20 months); nephrotic syndrome was completely abolished and kidney function recovered.
