Abstract: SA-PO240
Paraneoplastic Membranoproliferative Glomerulonephritis Associated with Neoplasm Transformation
Session Information
- Onconephrology: Immunological Cross-Talk
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Ratnani, Pardeep, Baylor College of Medicine, Houston, Texas, United States
- Mamlouk, Omar, The University of Texas MD Anderson Cancer Center Children's Cancer Hospital, Houston, Texas, United States
- Lahoti, Amit, The University of Texas MD Anderson Cancer Center Children's Cancer Hospital, Houston, Texas, United States
- Al Shaarani, Majd, The University of Texas System, Houston, Texas, United States
Introduction
Paraneoplastic glomerulonephritis is a rare complication of malignancy and early recognition could prevent ineffective and potentially harmful therapy. The mechanism is unclear and doesn’t appear to be correlated with the tumor burden, invasion, or metastasis but possibly with the by-products of tumor cells. We present an interesting and rarely reported case of paraneoplastic proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) associated with Diffuse large B-cell Lymphoma ( DLBCL) that responded to Cyclophosphamide/doxorubicin/prednisone/rituximab/Vincristine ( R-CHOP).
Case Description
A 63-year-old woman with a history of hypertension, and chronic lymphocytic leukemia(CLL) failed two lines of therapy admitted to the hospital for a second opinion. She was recently admitted for severe acute kidney injury (AKI) attributed to chemotoxicity with partial recovery upon therapy cessation. On exam, the patient appeared hypervolemia, with labs notable for acute kidney injury. Urinalysis with hematuria and 3+ proteinuria; urine protein: creatinine ratio of 1.9gm/24hr. A secondary workup showed Low C3, M protein < 0.1 g/dL, and SPEP/IFE showed a small protein peak in the gamma region ( IgG2 kappa). The renal biopsy showed Membranoproliferative glomerulonephritis with a monoclonal IgG deposit (IgG2 Kappa). PET scan significant for hypermetabolic soft tissue lesion in the oropharynx with tonsil biopsy confirming the transformation of CLL to DLBCL. The patient received R-CHOP with subsequent improvement in renal function and proteinuria.
Discussion
PGNMID has previously been reported to be associated with hematological malignancies, including CLL and lymphomas, solid malignancies, and infections, in addition to Monoclonal gammopathy of renal significance(MGRS). Effective treatment requires differentiating between these associated conditions as treatment is directed toward that disease. Our patient had confirmed hematologic malignancy at the time of PGNMID, the diagnosis for which paraneoplastic PGNMID is more reasonable than MGRS. The observed paraproteinemia is likely evolved as a part of an underlying immunoproliferative disorder. Increased free light chain level has been considered an adverse prognostic factor and early chemotherapy is emphasized for patients with PGNMID-associated hematological malignancies.