Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

Samih H. Nasr, Tait D. Shanafelt, Curtis A. Hanson, Mary E. Fidler, Lynn D. Cornell, Sanjeev M Sethi, Kari G. Chaffee, Joseph Morris, Nelson Leung

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4 Scopus citations

Abstract

Granulomatous interstitial nephritis (GIN) is an uncommon pathologic lesion encountered in 0.5% to 5.9% of renal biopsies. Drugs, sarcoidosis, and infections are responsible for most cases of GIN. Malignancy is not an established cause of GIN. Here, we report a series of 5 patients with GIN secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Patients were mostly elderly white males with an established history of CLL/SLL who presented with severe renal impairment (median peak serum creatinine, 7.3 mg/dL), leukocyturia, and mild proteinuria. One had nephromegaly. In 2 patients, the development and relapse of renal insufficiency closely paralleled the level of lymphocytosis. Kidney biopsy in all patients showed GIN concomitant with CLL/SLL leukemic interstitial infiltration. Granulomas were nonnecrotizing and epithelioid and were associated with giant cells. One biopsy showed granulomatous arteritis. One patient had a granulomatous reaction in lymph nodes and skin. Steroids with/without CLL/SLL-directed chemotherapy led to partial improvement of kidney function in all patients except 1 who had advanced cortical scarring on biopsy. In conclusion, we report an association between CLL/SLL and GIN. Patients typically present with severe renal failure due to both GIN and leukemic interstitial infiltration, which tends to respond to steroids with/without CLL/SLL-directed chemotherapy. The pathogenesis of GIN in this clinical setting is unknown but may represent a local hypersensitivity reaction to the CLL/SLL tumor cells.

Original languageEnglish (US)
Pages (from-to)130-136
Number of pages7
JournalAnnals of Diagnostic Pathology
Volume19
Issue number3
DOIs
StatePublished - Jun 1 2015

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Keywords

  • chronic lymphocytic leukemia
  • Granulomatous interstitial nephritis
  • interstitial nephritis
  • kidney biopsy
  • lymphoma
  • small lymphocytic lymphoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Nasr, S. H., Shanafelt, T. D., Hanson, C. A., Fidler, M. E., Cornell, L. D., Sethi, S. M., Chaffee, K. G., Morris, J., & Leung, N. (2015). Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma. Annals of Diagnostic Pathology, 19(3), 130-136. https://doi.org/10.1016/j.anndiagpath.2015.03.003