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Acute Kidney Injury and CLL: Case Study

By: Joshua D. Madera, MS
Posted: Tuesday, January 12, 2021

For patients with chronic lymphoid leukemia (CLL), acute kidney injury can manifest as the initial presentation of CLL due to leukemic infiltration, as explained in a Letter to the Editor published in the Turkish Journal of Haematology. However, in this case study, treatment of the patient’s CLL resolved the renal impairment, explained Kenan Keven, MD, PhD, of Ankara University, Turkey, and colleagues.

“Physicians should be aware of the atypical presentation of the disease [CLL],” stated the authors.

The patient was a 72-year-old male who presented with weight loss and general malaise. The patient’s history was significant for B-cell CLL, which was treated with rituximab and bendamustine. Upon physical examination, the patient had hepatomegaly and general lymphadenopathy. Further analysis with complete blood cell count revealed decreased hemoglobin levels, leukocytosis, and thrombocytosis. Overall, the results were consistent with CLL. Additional laboratory testing revealed elevated serum creatinine, elevated blood urea nitrogen, and decreased estimated glomerular filtration rate. Furthermore, increased levels of serum-free light chain kappa were identified.

Although renal ultrasound was unremarkable, a renal biopsy revealed diffuse monomorphic neoplastic lymphocytes infiltrating the interstitium. In addition, there was an indication of acute tubular necrosis and several sclerotic glomeruli. Positive CD5 and CD20 biomarker expression was identified via immunohistochemistry. The findings from the physical exam and laboratory analysis were consistent with lymphocytic infiltration resulting in acute kidney injury.

To alleviate the patient’s discomfort, leukapheresis as well as high-dose rituximab and methylprednisolone were administered. This therapeutic intervention led to improvement in renal function, as indicated by improved hemoglobin, leukocyte, and platelet levels.

Disclosure: For full disclosures of the study authors, visit jag.journalagent.com.



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