Abstract: SA-PO1156
Incidental Diagnosis of Lymphoplasmacytic Lymphoma in a Patient with CKD
Session Information
- CKD: Patient-Oriented Care and Case Reports
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Khan, Muhammad Riaz, Albany Medical Center, Albany, New York, United States
- Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States
Introduction
Lymphoplasmacytic lymphoma (LPL) is a rare B cell lymphoma, predominantly affecting whites and males, with a median onset age of 65. It mainly targets the bone marrow, and less frequently the spleen and lymph nodes, with kidney involvement being exceptionally rare. LPL often harbors mutations in the MYD88 gene and may not present with typical B symptoms. It is commonly associated with IgM monoclonal gammopathy, known as Waldenström gammaglobulinemia. This report describes an incidental finding of LPL in the kidney of an asymptomatic patient.
Case Description
A 76-year-old male with a history of chronic kidney disease (CKD) stage 3A presented for CKD management. Diagnosed concurrently with hypertension eight years prior, he had no known CKD risk factors. He was a non-smoker without illicit drug use. His medication regimen included irbesartan, hydrochlorothiazide, nifedipine, levothyroxine, atorvastatin, and multivitamins. He had a history of surgically treated prostate cancer and thyroid papillary carcinoma, 11 years ago. No family history of kidney disease was reported. Physical examination showed elevated blood pressure and 1+ lower extremity edema. Labs showed creatinine 1.38 mg/dl and no proteinuria with bland urinalysis. Kidney ultrasound identified bilateral simple renal cysts and a persistent complex cyst in the right kidney. Regular surveillance of the cyst was advised. During subsequent follow-up he reported 9 kg weight loss but no other symptoms. Repeat labs showed creatinine 1.48 mg/dl and normal blood counts. Renal biopsy was done which revealed LPL with a MYD88 mutation. Subsequent diagnoses included Waldenström gammaglobulinemia, with immunoelectrophoresis detecting IgM kappa paraprotein. He was referred to hematology/oncology for further evaluation and treatment, receiving six cycles of Rituximab, Bendamustine, and Neulasta, resulting in normalized IgM levels and creatinine remained stable at 1.46 mg/dl.
Discussion
LPL in the kidney is exceedingly uncommon, with few case reports available. This case emphasizes the significance of renal biopsy in patients with stable renal function and unidentified causes of CKD, highlighting its utility in revealing unusual pathologies even when initial evaluations are inconclusive.