Kidney International Reports (Mar 2022)

A Diverse Spectrum of Immune Complex– and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma

  • Nicole K. Andeen,
  • Shahad Abdulameer,
  • Vivek Charu,
  • Jonathan E. Zuckerman,
  • Megan Troxell,
  • Neeraja Kambham,
  • Charles E. Alpers,
  • Behzad Najafian,
  • Roberto F. Nicosia,
  • Kelly D. Smith,
  • Vanderlene L. Kung,
  • Rupali S. Avasare,
  • Anusha Vallurupalli,
  • J. Ashley Jefferson,
  • Douglas Hecox,
  • Leah Swetnam,
  • Michifumi Yamashita,
  • Mercury Lin,
  • Mei Lin Bissonnette,
  • Shreeram Akilesh,
  • Jean Hou

Journal volume & issue
Vol. 7, no. 3
pp. 568 – 579

Abstract

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Introduction: There are limited reports on kidney biopsy findings in patients with mantle cell lymphoma (MCL). Methods: We initiated a multi-institutional, retrospective review of kidney biopsy findings in patients with active and treated MCL. Results: A total of 30 patients with MCL and kidney biopsies were identified, with a median age of 67 (range 48–87) years, 73% of whom were men. A total of 20 patients had active MCL at the time of biopsy, of whom 14 (70%) presented with acute kidney injury (AKI), proteinuria and/or hematuria, and biopsy findings potentially attributable to lymphoma. Of the 14, 11 had immune complex (IC) or complement-mediated (C3) disease including proliferative glomerulonephritis (GN) with monotypic Ig deposits (PGNMID [2]), C3GN, (2), secondary membranous nephropathy (MN [3]), tubular basement membrane (TBM) deposits (2), and modest lupus-like GN (2). Lymphomatous infiltration was present in 8 of the 20 patients, 5 with coincident IC or C3 lesions. A total of 6 patients with available follow-up were treated for MCL, all with clinical remission of GN (2 PGNMID, 2 C3GN, and 2 MN). Conclusion: MCL is associated with diverse monoclonal and polyclonal glomerular and extra-glomerular IC and C3 disease. For patients with active MCL and kidney dysfunction requiring biopsy, 70% had findings due or potentially due to lymphoma, including 55% with IC or C3 disease and 40% had lymphomatous kidney infiltration. IC and C3GN in the setting of active MCL was responsive to lymphoma-directed therapy.

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