Meltem Sezis Demirci1*, Cenk Gokalp1, Cenk Demirci1, Emrah Gunay1, Ayhan Donmez2, Sait Sen3 and Mehmet Ozkahya1
1Ege University Hospital, Nephrology Department, Izmir, Turkey
2Ege University Hospital, Hematology Department, Izmir, Turkey
3Ege University Hospital, Pathology Department, Izmir, Turkey
Received: 13 June, 2016; Accepted: 11 August, 2016; Published: 13 August, 2016
Meltem Sezis Demirci, Ege University Hospital, Nephrology Department, Izmir, Turkey, E-mail:
Demirci MS, Gokalp C, Demirci C, Gunay E, Donmez A, et al. (2016) Membranoproliferative Glomerulonephritis Preceding Non-Hodgkin Lymphoma Recurrence: A Case Report. Arch Renal Dis Manag 2(1): 024-025. DOI: 10.17352/2455-5495.000012
© 2016 Demirci MS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Membranoproliferative glomerulonephritis; Non-Hodgkin lymphoma; Nephrotic syndrome
Introduction: Membranoproliferative glomerulonephritis has been reported to occur in association with non-Hodgkin’s lymphoma but there is few information about glomerulonephritis response to the treatment of non-Hodgkin’s lymphoma.
Case Presentation: A 67 years-old caucasian female admitted to outpatient clinic with peripheral edema complaint. She had mild proteinuria and microhematuria on admission and tuberculosis, non-Hodgkin lymphoma (cured), diabetes mellitus and hypertension history. Her renal biopsy resulted as membranoproliferative glomerulonephritis and after investigations she got recurrent non-Hodgkin lymphoma diagnosis. After successful treatment of her lymphoma her nephrotic syndrome clinic regressed.
Conclusion: Membranoproliferative glomerulonephritis has been known to be associated with non-Hodgkin’s lymphoma. There is limited information available concerning the effects of treatment of non-Hodgkin’s lymphoma on the progression of non-Hodgkin’s lymphoma associated membranoproliferative glomerulonephritis. We report a rare case of non-Hodgkin’s lymphoma associated membranoproliferative glomerulonephritis, that continued to be in remission after chemotherapy treatment of lymphoma.
Membranoproliferative GN (MPGN) accounts for approximately 7%–10% of biopsy-confirmed GN . Clinical presentation varies between mild hematuria/proteinuria and nephrotic syndrome. MPGN can be associated with infections, autoimmune diseases and paraproteinemias . MPGN has been associated with Non-Hodgkin’s lymphoma , besides there is a few information concerning the effects of treatment of NHL on the clinically associated MPGN.
This report describes a patient who was diagnosed with non-Hodgkin lymphoma after presentation with nephrotic syndrome. Nephrotic syndrome findings of the patient regressed after treatment of lymphoma with chemotherapy.
A 67 years-old caucasian female patient admitted to hospital with lower extremity edema and dyspnea. She had 2(+) pitting edema on bilateral legs, her chest examination revealed bilateral basal crackles. She had tuberculosis (diagnosed and treated at 1979 and 2012), non-Hodgkin lymphoma (diagnosed at 2006, treated with 6 cycles of chemotherapy), diabetes mellitus (for 25 years) and hypertension (for 6 months) history. She had 4.9 gr/day proteinuria, microscopic hematuria and hypoalbuminemia with normal creatinine value at admission. Her ANA and ANCA results were negative, Erythrocyte Sedimentation Rate (ESR) was 81, CRP: 1,51 mg/dL, C3: 86, C4: <4, Cryoglobulin resulted as 2(+). Renal biopsy was performed and resulted as membranoproliferative glomerulonephritis with positive C1Q, C3C, IgM, IgA, Kappa immunofluorescein stain. Light microscopic findings of glomerulus showing, endocapillary hypercellularity, and double contours. H&E staining (magnification, × 400) Light microscopic findings of glomerulus showing, endocapillary hypercellularity, and double contours. H&E staining (magnification, × 400) (Figure 1). She had been consulted to hematology department and after the evaluation bone marrow aspiration and biopsy was normal but multiple lymphadenopathies at submandibular, supraclavicular, mediastinal, intraperitoneal and paraaortic lymph nodes observed at her whole-body computerized tomography and PET/CT. Besides multiple lymphadenopathies, ground glass appearance at posterobasal segment of left lower lobe of lung. In order to differentiate any possible infections or malignancy, bronchoscopy was done but cytologic examination was negative for malignant disease. Two weeks of antibiotherapy administered for that consolidation but control PET/CT was showed morphologic and metabolic progression of that consolidated lesion. So another bronchoscopy was done with a tru-cut biopsy and pathology resulted as plasmacytic differentiated MALT lymphoma. After re-evaluation by hematology department patient is considered as relaps lymphoma and she was treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy. After 6 cycles of chemotherapy her proteinuria was regressed and her serum albumin level increased to normal level (Table 1). Besides the treatment of lymphoma, her cryoglobulin levels did not change, so glomerulonephritis was secondary to lymphoma not cryoglobulinemia.
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