Proteinuria, Hypoalbuminemia, and Chronic Lymphocytic Leukemia

An Unusual Trio

Research output: Contribution to journalArticle

Abstract

Chronic lymphocytic leukemia (CLL) is a chronic, progressive lymphoproliferative disorder characterized by a monoclonal population of functionally incompetent lymphocytes. Renal involvement is rare and poorly described. A 57-year-old male with no prior medical history was diagnosed with CLL and followed with a watch and wait approach. He was referred to our institution several months later due to concern for Richter’s transformation to diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan showed no evidence of diffuse large B-cell lymphoma; however, the patient was noted to have hypoalbuminemia, nephrotic range proteinuria, an acute left renal vein thrombus, and a right pulmonary embolus. A nephrotic syndrome workup including autoimmunity and infection was unremarkable, and a kidney biopsy was deferred due to concern for renal compromise in the setting of a renal vein thrombus. The patient was treated with 6 cycles of reduced-dose fludarabine, cyclophosphamide, and rituximab for a presumed CLL-associated nephrotic syndrome and anticoagulation for his venous thromboemboli. At 6-month follow-up, the patient achieved complete remission of his CLL with normalization of all cell lines and resolution of his nephrotic range proteinuria. Repeat computed tomography scans showed no evidence of recurrent venous thromboemboli. This case demonstrates a potential role of empiric chemotherapy in cases of CLL-associated nephrotic syndrome given its potentially life-threatening sequelae and response to treatment.

Original languageEnglish (US)
JournalJournal of Investigative Medicine High Impact Case Reports
Volume6
DOIs
StatePublished - Mar 12 2018

Fingerprint

Hypoalbuminemia
B-Cell Chronic Lymphocytic Leukemia
Proteinuria
Cells
Nephrotic Syndrome
empirics
Tomography
normalization
Renal Veins
Lymphoma, Large B-Cell, Diffuse
compromise
evidence
Positron emission tomography
Kidney
Chemotherapy
Lymphocytes
Biopsy
Watches
Thrombosis
Lymphoproliferative Disorders

Keywords

  • chronic lymphocytic leukemia
  • nephrotic syndrome
  • venous thromboemboli

ASJC Scopus subject areas

  • Epidemiology
  • Safety, Risk, Reliability and Quality
  • Safety Research

Cite this

@article{f5006144ff994ea78d6d26725aa436ca,
title = "Proteinuria, Hypoalbuminemia, and Chronic Lymphocytic Leukemia: An Unusual Trio",
abstract = "Chronic lymphocytic leukemia (CLL) is a chronic, progressive lymphoproliferative disorder characterized by a monoclonal population of functionally incompetent lymphocytes. Renal involvement is rare and poorly described. A 57-year-old male with no prior medical history was diagnosed with CLL and followed with a watch and wait approach. He was referred to our institution several months later due to concern for Richter’s transformation to diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan showed no evidence of diffuse large B-cell lymphoma; however, the patient was noted to have hypoalbuminemia, nephrotic range proteinuria, an acute left renal vein thrombus, and a right pulmonary embolus. A nephrotic syndrome workup including autoimmunity and infection was unremarkable, and a kidney biopsy was deferred due to concern for renal compromise in the setting of a renal vein thrombus. The patient was treated with 6 cycles of reduced-dose fludarabine, cyclophosphamide, and rituximab for a presumed CLL-associated nephrotic syndrome and anticoagulation for his venous thromboemboli. At 6-month follow-up, the patient achieved complete remission of his CLL with normalization of all cell lines and resolution of his nephrotic range proteinuria. Repeat computed tomography scans showed no evidence of recurrent venous thromboemboli. This case demonstrates a potential role of empiric chemotherapy in cases of CLL-associated nephrotic syndrome given its potentially life-threatening sequelae and response to treatment.",
keywords = "chronic lymphocytic leukemia, nephrotic syndrome, venous thromboemboli",
author = "William Wung and Shubha Ananthakrishnan and Brian Jonas",
year = "2018",
month = "3",
day = "12",
doi = "10.1177/2324709618764207",
language = "English (US)",
volume = "6",
journal = "Journal of Investigative Medicine High Impact Case Reports",
issn = "2324-7096",
publisher = "Sage Publications",

}

TY - JOUR

T1 - Proteinuria, Hypoalbuminemia, and Chronic Lymphocytic Leukemia

T2 - An Unusual Trio

AU - Wung, William

AU - Ananthakrishnan, Shubha

AU - Jonas, Brian

PY - 2018/3/12

Y1 - 2018/3/12

N2 - Chronic lymphocytic leukemia (CLL) is a chronic, progressive lymphoproliferative disorder characterized by a monoclonal population of functionally incompetent lymphocytes. Renal involvement is rare and poorly described. A 57-year-old male with no prior medical history was diagnosed with CLL and followed with a watch and wait approach. He was referred to our institution several months later due to concern for Richter’s transformation to diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan showed no evidence of diffuse large B-cell lymphoma; however, the patient was noted to have hypoalbuminemia, nephrotic range proteinuria, an acute left renal vein thrombus, and a right pulmonary embolus. A nephrotic syndrome workup including autoimmunity and infection was unremarkable, and a kidney biopsy was deferred due to concern for renal compromise in the setting of a renal vein thrombus. The patient was treated with 6 cycles of reduced-dose fludarabine, cyclophosphamide, and rituximab for a presumed CLL-associated nephrotic syndrome and anticoagulation for his venous thromboemboli. At 6-month follow-up, the patient achieved complete remission of his CLL with normalization of all cell lines and resolution of his nephrotic range proteinuria. Repeat computed tomography scans showed no evidence of recurrent venous thromboemboli. This case demonstrates a potential role of empiric chemotherapy in cases of CLL-associated nephrotic syndrome given its potentially life-threatening sequelae and response to treatment.

AB - Chronic lymphocytic leukemia (CLL) is a chronic, progressive lymphoproliferative disorder characterized by a monoclonal population of functionally incompetent lymphocytes. Renal involvement is rare and poorly described. A 57-year-old male with no prior medical history was diagnosed with CLL and followed with a watch and wait approach. He was referred to our institution several months later due to concern for Richter’s transformation to diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan showed no evidence of diffuse large B-cell lymphoma; however, the patient was noted to have hypoalbuminemia, nephrotic range proteinuria, an acute left renal vein thrombus, and a right pulmonary embolus. A nephrotic syndrome workup including autoimmunity and infection was unremarkable, and a kidney biopsy was deferred due to concern for renal compromise in the setting of a renal vein thrombus. The patient was treated with 6 cycles of reduced-dose fludarabine, cyclophosphamide, and rituximab for a presumed CLL-associated nephrotic syndrome and anticoagulation for his venous thromboemboli. At 6-month follow-up, the patient achieved complete remission of his CLL with normalization of all cell lines and resolution of his nephrotic range proteinuria. Repeat computed tomography scans showed no evidence of recurrent venous thromboemboli. This case demonstrates a potential role of empiric chemotherapy in cases of CLL-associated nephrotic syndrome given its potentially life-threatening sequelae and response to treatment.

KW - chronic lymphocytic leukemia

KW - nephrotic syndrome

KW - venous thromboemboli

UR - http://www.scopus.com/inward/record.url?scp=85065004268&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065004268&partnerID=8YFLogxK

U2 - 10.1177/2324709618764207

DO - 10.1177/2324709618764207

M3 - Article

VL - 6

JO - Journal of Investigative Medicine High Impact Case Reports

JF - Journal of Investigative Medicine High Impact Case Reports

SN - 2324-7096

ER -