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there are other patterns of renal damage associated with lymphomas&#44; such as the association of minimal-change disease with Hodgkin&#8217;s lymphoma&#44; in which this glomerulopathy accounts for 40&#37; of all cases with renal disease&#46;<span class="elsevierStyleSup">3</span> On the contrary&#44; the association of membranoproliferative glomerulonephritis and lymphoma is much less frequent than the rate published for this glomerular disease with regard to solid organ tumours&#46;<span class="elsevierStyleSup">1</span> Renal damage associated with paraproteins synthesised by lymphoplasmacytic lymphoma is a rare occurrence&#44; despite the fact that approximately 20&#37; of lymphoplasmacytic lymphomas progress with cryoglobulinemia and the almost always present IgM kappa monoclonal gammopathy&#46;<span class="elsevierStyleSup">4</span> Cases have been described in the medical literature of light-chain disease&#44;<span class="elsevierStyleSup">5</span> amyloidosis&#44;<span class="elsevierStyleSup">5</span> and immunotactoid glomerulonephritis<span class="elsevierStyleSup">6</span> as causes of proteinuria and renal failure in patients with lymphoma&#46; Here&#44; we present&#44; in chronological order&#44; an example of the association between the appearance of paraproteinemia&#44; membranoproliferative glomerulonephritis&#44; and a clinically evident lymphoplasmacytic lymphoma &#40;LPL&#41; in the absence of infection by hepatitis C virus &#40;HCV&#41;&#44; which shows the polymorphic manifestations that lymphomas can take in the kidney&#44; as well as the value of nephropathology in the diagnosis and prognosis of a haematological disease that presents with paraproteinemia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASE</span></p><p class="elsevierStylePara">Our patient was a 39-year-old male&#44; with no toxic habits&#44; allergic to acetyl-salicylic acid &#40;ASA&#41; and diclofenac&#46; He initially sought treatment for swelling of the soft tissues associated with palpable purpura in the lower extremities in April 2001&#46; We performed an immunological analysis that revealed positive cryoglobulinemia with a cryocrit of 9&#46;2&#37; &#40;monoclonal IgM kappa and IgG component&#41;&#46; Serology tests for hepatotropic virus and human immunodeficiency virus &#40;HIV&#41; were negative&#44; and the antiphospholipid antibody test was also negative&#46;</p><p class="elsevierStylePara">A physical examination revealed the presence of palpable purpura in the lower extremities&#59; the rest of the exam was normal&#46; He underwent thoraco-abdominal computerised tomography &#40;CT&#41; that did not show any evidence of adenopathies or visceromegalies&#46; Diagnosed with cutaneous vasculitis&#44; the patient was prescribed prednisone at 1mg&#47;kg&#47;day&#44; with favourable initial evolution and the disappearance of lesions&#46;</p><p class="elsevierStylePara">One year after the first medical visit&#44; the patient complained of paraesthesia in the lower extremities&#44; again associated with petechiae in the same area&#44; and on this occasion the patient also had nephritic syndrome&#46; The laboratory analysis resulted in&#58; hypocomplementemia&#44; cryocrit of 17&#37;&#44; and a proteinogram with a weak anomalous band in the gamma zone&#46; The serum immunoelectrophoresis showed restricted mobility IgM kappa component &#40;there was no evidence of monoclonality in the urine&#41;&#46; Renal function included a creatinine level of 1&#46;2mg&#47;dl&#44; sediments with &#43;&#43;&#43; red blood cells&#44; and proteinuria at 2&#46;8g&#47;day&#46;</p><p class="elsevierStylePara">A kidney biopsy confirmed the presence of glomerulonephritis with a mesangiocapillary pattern &#40;Figure 1&#41;&#46; We added azathioprine to the treatment regimen&#44; maintaining renal function and proteinuria close to 1g&#47;day&#46;</p><p class="elsevierStylePara">After 6 months of follow-up&#44; a control laboratory test revealed an immunophenotype that was compatible with LPL in a peripheral blood sample&#46; This finding was later confirmed through a bone marrow aspiration that revealed medullary infiltration from small-type B-cell chronic lymphoproliferative syndrome&#44; compatible with quiescent LPL&#44; and so at this point the patient was no longer given chemotherapy&#46;</p><p class="elsevierStylePara">One year later&#44; the patient developed persistent proteinuria &#40;4&#46;7g&#47;24h&#41;&#44; for which we took another renal biopsy that confirmed the presence of cryoglobulinemic glomerulonephritis&#44; and also showed lymphocyte infiltration compatible with low-grade B-cell lymphoma &#40;Figure 2&#41;&#46; Given the renal involvement of the lymphoma&#44; we decided to start treatment with subcutaneous rituximab at 375mg&#47;m<span class="elsevierStyleSup">2</span>x4 and a cycle of plasma exchange&#46;</p><p class="elsevierStylePara">Two years after receiving anti-CD20 treatment&#44; the patient currently has lymphoproliferative syndrome that is in remission&#44; and the renal damage continues in the form of residual proteinuria &#40;4g&#47;day&#41;&#44; with conserved renal function &#40;Cr&#58; 0&#46;8mg&#47;dl&#44; GFR&#58; 100ml&#47;min&#41; and treatment with dual blockade of the renin-angiotensin-aldosterone system &#40;Figure 3&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">In addition to the peculiar clinical progression of this patient&#44; in which mixed cryoglobulinemia was the first manifestation of LPL&#44; this case exemplifies the rare association between lymphoma and cryoglobulin-associated glomerulonephritis&#46; The absence of HCV stands out&#44; since it is common in patients with the combination of cryoglobulinemia&#44; glomerular disease&#44; and lymphoproliferative syndrome&#46;</p><p class="elsevierStylePara">The majority of cases of LPL show up in serum samples with IgM paraprotein&#44; and 20&#37; of this paraprotein may be cryoglobulins that can result in auto-immune phenomena&#44; such as in this case&#44; or a protein that could cause a coagulopathy due to the bond of IgM to coagulation factors&#44; platelets&#44; and fibrin&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The best therapeutic option in this clinical context is anti-lymphoproliferative treatment in order to slow the growth of the tumour mass&#44; and elimination of the paraprotein that was secreted by the lymphoma using plasma exchange &#40;PE&#41;&#46;</p><p class="elsevierStylePara">In a multi-centre retrospective study of 33 cases of mixed cryoglobulinemia that were initially classified as idiopathic&#44; the cause of the condition was established in 20 patients&#46; Following a mean follow-up period of 67&#46;2 months&#44; the results were 14 cases of autoimmune disease&#44; two cases secondary to infections not related to HCV&#44; and four patients with lymphoma&#46; This study&#44; as in our case&#44; demonstrated the usefulness of long-term follow-up in patients with idiopathic cryoglobulinemia&#44; including the evaluation of renal function and urine sediment&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">Another study described in the medical literature examined 18 patients with increased serum creatinine levels and&#44; in many cases&#44; proteinuria&#46; The renal biopsy puncture showed direct damage to the kidney from several neoplasias&#44; including CLL&#47;small lymphocytic lymphoma &#40;n&#61;7&#41;&#44; diffuse large B-cell lymphoma &#40;n&#61;6&#41;&#44; multiple myeloma &#40;n&#61;4&#41;&#44; and B-cell lymphoblastic lymphoma &#40;n&#61;1&#41;&#46;</p><p class="elsevierStylePara">In 10 cases &#40;55&#37;&#41;&#44; there was a coexisting glomerular pathology&#58; five had glomerulonephritis with membranoproliferative patterns &#40;n&#61;4&#41; and membranous nephropathy &#40;n&#61;1&#41;&#44; characterised by immune complex deposits&#59; two had immunoglobulin deposit with a monoclonal component of amyloid lambda light chains &#40;n&#61;1&#41;&#44; and light-chain deposition disease &#40;n&#61;1&#41;&#59; two had minimal change disease&#44; and one patient had focal pauci-immune crescentic glomerulonephritis&#46; Additionally&#44; one biopsy revealed diabetic nephropathy&#44; and three cases had non-specific ischaemic changes&#46; In the four remaining cases there were no significant glomerular changes&#46; In 11 cases &#40;61&#37;&#41;&#44; the diagnosis of lymphoproliferative syndrome was made after renal biopsy&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">This case highlights the usefulness of renal biopsies as a diagnostic tool for&#58; <span class="elsevierStyleItalic">1&#41;</span> better characterisation of the different stages of lymphomas with renal manifestations&#44; since they can be polymorphic&#44; as in our patient&#44; who progressed from nephritic syndrome to nephrotic syndrome&#44; and <span class="elsevierStyleItalic">2&#41;</span> as a biological substrate upon which to suggest an early treatment regimen for this type of haematological pathology&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">The kidneys can be a target organ in patients with LPL&#46; The early indication for renal biopsy in patients with renal damage and LPL will allow us to determine other rare patterns of renal damage that are produced in patients with this type of lymphoma&#44; and thus avoid under-registering the association between nephropathy and LPL&#46;</p><p class="elsevierStylePara">Additionally&#44; renal biopsies in these patients will facilitate a rapid diagnosis and early start of chemotherapy&#44; which is a key factor in the renal recovery of patients with oncohaematological diseases&#46;</p><p class="elsevierStylePara">Based on these conclusions&#44; the relevance of analysing renal function and the urine sediment in the follow-up of patients with lymphoma is highlighted&#44; as well as cooperation with pathologists&#44; allowing for a clinical-pathological partnership throughout the evolution of this disease&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24595&#95;en&#95;fig&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24595_en_fig_1.jpg" alt="Proliferative glomerulonephritis with a mesangiocapillary pattern"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Proliferative glomerulonephritis with a mesangiocapillary pattern</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24596&#95;en&#95;f2&#95;a&#95;y&#95;b&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24596_en_f2_a_y_b.jpg" alt="A&#58; dense lymphocyte infiltration by B-lymphocytes compatible with B-cell lymphoma &#40;haematoxylin-eosin&#41;&#46; B&#58; immunohistochemistry confirmed the diagnosis of lymphoplasmacytic lymphoma&#44; and the figure shows the positive CD20 staining"></img></a></p><p class="elsevierStylePara">Figure 2&#46; A&#58; dense lymphocyte infiltration by B-lymphocytes compatible with B-cell lymphoma &#40;haematoxylin-eosin&#41;&#46; B&#58; immunohistochemistry confirmed the diagnosis of lymphoplasmacytic lymphoma&#44; and the figure shows the positive CD20 staining</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24597&#95;en&#95;f3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24597_en_f3.jpg" alt="Schematic of the clinical progression &#40;follow-up over 10 years&#41; from the start of cutaneous vasculitis from cryoglobulins to the diagnosis and treatment of lymphoplasmacytic lymphoma"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Schematic of the clinical progression &#40;follow-up over 10 years&#41; from the start of cutaneous vasculitis from cryoglobulins to the diagnosis and treatment of lymphoplasmacytic lymphoma</p>"
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        "resumen" => "<p class="elsevierStylePara">La afectaci&#243;n renal asociada a linfoma es un fen&#243;meno conocido pero frecuentemente no caracterizado debido a la baja frecuencia con que se realizan biopsias en estos pacientes&#46; Varios patrones histol&#243;gicos pueden coexistir y pasar desapercibidos sin un estudio histopatol&#243;gico&#46; La infiltraci&#243;n parenquimatosa renal por linfoma no es infrecuente&#44; y se ha encontrado hasta en un 34&#37; &#40;<span class="elsevierStyleItalic">post mortem</span>&#41; y 14&#37; &#40;<span class="elsevierStyleItalic">pre mortem</span>&#41;&#44; aunque tiene una baja incidencia de manifestaciones cl&#237;nicas&#46;&#160;Existen diferentes patrones de lesi&#243;n renal asociados a linfoma y destaca la asociaci&#243;n de&#160;enfermedad de cambios m&#237;nimos con linfoma&#160; de Hodgkin&#46; La afectaci&#243;n&#160;renal asociada a paraprote&#237;nas sintetizadas por un linfoma&#160;linfoplasmocitario es una asociaci&#243;n excepcional pese a que existen un&#160;20&#37; de pacientes afectados por dichos linfomas que&#160;presentan crioglobulinemia&#46; En la literatura&#160;se han publicado&#160;casos&#160;de enfermedad de cadenas ligeras&#44; amiloidosis&#44; glomerulonefritis inmunotactoide como causas de paraproteinemia&#44; proteinuria e insuficiencia renal en pacientes con linfoma&#46; Presentamos un caso de asociaci&#243;n entre paraproteinemia&#44; glomerulonefritis membrano-proliferativa y la aparici&#243;n cl&#237;nicamente evidente de un linfoma linfoplasmocitario en ausencia de infecci&#243;n por virus de la hepatitis C&#46; Esto demuestra la afectaci&#243;n&#160;polimorfa que pueden presentar los linfomas en el ri&#241;&#243;n y el valor de la nefropatolog&#237;a en el diagn&#243;stico y pron&#243;stico de las enfermedades hematol&#243;gicas que cursan con paraproteinemia&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic">Kidney involvement associated to lymphoma is a known phenomenon&#160; but frequently not characterized due to the low frequency with which biopsies are realized in these patients&#46; Several histological patterns can co-exist and happen unnoticed without a biopsy&#46; Parenchyma infiltration in kidney for lymphoma&#160; has been found in 34&#37; &#40;post-mortem&#41; and 14&#37; &#40;pre-mortem&#41; and &#160;have low incident of clinical manifestations&#46; Other&#160;patterns of renal injury are associated to lymphomaand minimal changes disease is especially related with Hodgkin&#8217;s lymphoma&#46;&#160;Renal lesions associated to paraprotein in lymphoplasmocitic lymphoma are an exceptional association&#44; in spite of in 20&#37; of them&#44; appear cryoglobulinemia&#46; There are a few cases reported in the literature with different histological patterns&#58; light-chain disease&#44; amyloidosis&#44; and immuotactoid glomerulopathy related with kidney injury in patients with lymphoma&#46; A 39-year-old male presented an association among&#160;paraproteinemia&#44; membrano-proliferative glomerulonephritis no hepatitis C virus related and lymphoplasmocitic lymphoma with renal infiltration&#46;&#160;This case emphasized the variety of&#160;renal lesions&#160;that lymphomas could trigger and the value of the nephropatology in the diagnosis and outcome of the hematologic diseases with paraproteinemia&#46;</span></p>"
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Mixed cryoglobulinaemia not related to hepatitis C virus, mesangiocapillary glomerulonephritis and lymphoplasmocytic lymphoma
Crioglobulinemia mixta no relacionada con virus de la hepatitis C, glomerulonefritis mesangiocapilar y linfoma linfoplasmocitario
Maria-Noel Martinaa, M.N.. Martinab, Manel Soléc, M.. Soléd, Elisabet Massóe, E.. Massób, Núria Pereze, N.. Perezb, Josep M. Campistole, J.M.. Campistolb, Luis F. Quintanae, L.F.. Quintanab
a Servicio de Nefrología y Trasplante Renal, Hospital Clinic, Barcelona, Spain,
b Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona,
c SERVICIO DE ANATOMIA PATOLOGICA, Hospital Clínic, Barcelona, Spain,
d Servicio de Anatomía Patológica, Hospital Clínic de Barcelona,
e Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain,
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there are other patterns of renal damage associated with lymphomas&#44; such as the association of minimal-change disease with Hodgkin&#8217;s lymphoma&#44; in which this glomerulopathy accounts for 40&#37; of all cases with renal disease&#46;<span class="elsevierStyleSup">3</span> On the contrary&#44; the association of membranoproliferative glomerulonephritis and lymphoma is much less frequent than the rate published for this glomerular disease with regard to solid organ tumours&#46;<span class="elsevierStyleSup">1</span> Renal damage associated with paraproteins synthesised by lymphoplasmacytic lymphoma is a rare occurrence&#44; despite the fact that approximately 20&#37; of lymphoplasmacytic lymphomas progress with cryoglobulinemia and the almost always present IgM kappa monoclonal gammopathy&#46;<span class="elsevierStyleSup">4</span> Cases have been described in the medical literature of light-chain disease&#44;<span class="elsevierStyleSup">5</span> amyloidosis&#44;<span class="elsevierStyleSup">5</span> and immunotactoid glomerulonephritis<span class="elsevierStyleSup">6</span> as causes of proteinuria and renal failure in patients with lymphoma&#46; Here&#44; we present&#44; in chronological order&#44; an example of the association between the appearance of paraproteinemia&#44; membranoproliferative glomerulonephritis&#44; and a clinically evident lymphoplasmacytic lymphoma &#40;LPL&#41; in the absence of infection by hepatitis C virus &#40;HCV&#41;&#44; which shows the polymorphic manifestations that lymphomas can take in the kidney&#44; as well as the value of nephropathology in the diagnosis and prognosis of a haematological disease that presents with paraproteinemia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASE</span></p><p class="elsevierStylePara">Our patient was a 39-year-old male&#44; with no toxic habits&#44; allergic to acetyl-salicylic acid &#40;ASA&#41; and diclofenac&#46; He initially sought treatment for swelling of the soft tissues associated with palpable purpura in the lower extremities in April 2001&#46; We performed an immunological analysis that revealed positive cryoglobulinemia with a cryocrit of 9&#46;2&#37; &#40;monoclonal IgM kappa and IgG component&#41;&#46; Serology tests for hepatotropic virus and human immunodeficiency virus &#40;HIV&#41; were negative&#44; and the antiphospholipid antibody test was also negative&#46;</p><p class="elsevierStylePara">A physical examination revealed the presence of palpable purpura in the lower extremities&#59; the rest of the exam was normal&#46; He underwent thoraco-abdominal computerised tomography &#40;CT&#41; that did not show any evidence of adenopathies or visceromegalies&#46; Diagnosed with cutaneous vasculitis&#44; the patient was prescribed prednisone at 1mg&#47;kg&#47;day&#44; with favourable initial evolution and the disappearance of lesions&#46;</p><p class="elsevierStylePara">One year after the first medical visit&#44; the patient complained of paraesthesia in the lower extremities&#44; again associated with petechiae in the same area&#44; and on this occasion the patient also had nephritic syndrome&#46; The laboratory analysis resulted in&#58; hypocomplementemia&#44; cryocrit of 17&#37;&#44; and a proteinogram with a weak anomalous band in the gamma zone&#46; The serum immunoelectrophoresis showed restricted mobility IgM kappa component &#40;there was no evidence of monoclonality in the urine&#41;&#46; Renal function included a creatinine level of 1&#46;2mg&#47;dl&#44; sediments with &#43;&#43;&#43; red blood cells&#44; and proteinuria at 2&#46;8g&#47;day&#46;</p><p class="elsevierStylePara">A kidney biopsy confirmed the presence of glomerulonephritis with a mesangiocapillary pattern &#40;Figure 1&#41;&#46; We added azathioprine to the treatment regimen&#44; maintaining renal function and proteinuria close to 1g&#47;day&#46;</p><p class="elsevierStylePara">After 6 months of follow-up&#44; a control laboratory test revealed an immunophenotype that was compatible with LPL in a peripheral blood sample&#46; This finding was later confirmed through a bone marrow aspiration that revealed medullary infiltration from small-type B-cell chronic lymphoproliferative syndrome&#44; compatible with quiescent LPL&#44; and so at this point the patient was no longer given chemotherapy&#46;</p><p class="elsevierStylePara">One year later&#44; the patient developed persistent proteinuria &#40;4&#46;7g&#47;24h&#41;&#44; for which we took another renal biopsy that confirmed the presence of cryoglobulinemic glomerulonephritis&#44; and also showed lymphocyte infiltration compatible with low-grade B-cell lymphoma &#40;Figure 2&#41;&#46; Given the renal involvement of the lymphoma&#44; we decided to start treatment with subcutaneous rituximab at 375mg&#47;m<span class="elsevierStyleSup">2</span>x4 and a cycle of plasma exchange&#46;</p><p class="elsevierStylePara">Two years after receiving anti-CD20 treatment&#44; the patient currently has lymphoproliferative syndrome that is in remission&#44; and the renal damage continues in the form of residual proteinuria &#40;4g&#47;day&#41;&#44; with conserved renal function &#40;Cr&#58; 0&#46;8mg&#47;dl&#44; GFR&#58; 100ml&#47;min&#41; and treatment with dual blockade of the renin-angiotensin-aldosterone system &#40;Figure 3&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">In addition to the peculiar clinical progression of this patient&#44; in which mixed cryoglobulinemia was the first manifestation of LPL&#44; this case exemplifies the rare association between lymphoma and cryoglobulin-associated glomerulonephritis&#46; The absence of HCV stands out&#44; since it is common in patients with the combination of cryoglobulinemia&#44; glomerular disease&#44; and lymphoproliferative syndrome&#46;</p><p class="elsevierStylePara">The majority of cases of LPL show up in serum samples with IgM paraprotein&#44; and 20&#37; of this paraprotein may be cryoglobulins that can result in auto-immune phenomena&#44; such as in this case&#44; or a protein that could cause a coagulopathy due to the bond of IgM to coagulation factors&#44; platelets&#44; and fibrin&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The best therapeutic option in this clinical context is anti-lymphoproliferative treatment in order to slow the growth of the tumour mass&#44; and elimination of the paraprotein that was secreted by the lymphoma using plasma exchange &#40;PE&#41;&#46;</p><p class="elsevierStylePara">In a multi-centre retrospective study of 33 cases of mixed cryoglobulinemia that were initially classified as idiopathic&#44; the cause of the condition was established in 20 patients&#46; Following a mean follow-up period of 67&#46;2 months&#44; the results were 14 cases of autoimmune disease&#44; two cases secondary to infections not related to HCV&#44; and four patients with lymphoma&#46; This study&#44; as in our case&#44; demonstrated the usefulness of long-term follow-up in patients with idiopathic cryoglobulinemia&#44; including the evaluation of renal function and urine sediment&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">Another study described in the medical literature examined 18 patients with increased serum creatinine levels and&#44; in many cases&#44; proteinuria&#46; The renal biopsy puncture showed direct damage to the kidney from several neoplasias&#44; including CLL&#47;small lymphocytic lymphoma &#40;n&#61;7&#41;&#44; diffuse large B-cell lymphoma &#40;n&#61;6&#41;&#44; multiple myeloma &#40;n&#61;4&#41;&#44; and B-cell lymphoblastic lymphoma &#40;n&#61;1&#41;&#46;</p><p class="elsevierStylePara">In 10 cases &#40;55&#37;&#41;&#44; there was a coexisting glomerular pathology&#58; five had glomerulonephritis with membranoproliferative patterns &#40;n&#61;4&#41; and membranous nephropathy &#40;n&#61;1&#41;&#44; characterised by immune complex deposits&#59; two had immunoglobulin deposit with a monoclonal component of amyloid lambda light chains &#40;n&#61;1&#41;&#44; and light-chain deposition disease &#40;n&#61;1&#41;&#59; two had minimal change disease&#44; and one patient had focal pauci-immune crescentic glomerulonephritis&#46; Additionally&#44; one biopsy revealed diabetic nephropathy&#44; and three cases had non-specific ischaemic changes&#46; In the four remaining cases there were no significant glomerular changes&#46; In 11 cases &#40;61&#37;&#41;&#44; the diagnosis of lymphoproliferative syndrome was made after renal biopsy&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">This case highlights the usefulness of renal biopsies as a diagnostic tool for&#58; <span class="elsevierStyleItalic">1&#41;</span> better characterisation of the different stages of lymphomas with renal manifestations&#44; since they can be polymorphic&#44; as in our patient&#44; who progressed from nephritic syndrome to nephrotic syndrome&#44; and <span class="elsevierStyleItalic">2&#41;</span> as a biological substrate upon which to suggest an early treatment regimen for this type of haematological pathology&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">The kidneys can be a target organ in patients with LPL&#46; The early indication for renal biopsy in patients with renal damage and LPL will allow us to determine other rare patterns of renal damage that are produced in patients with this type of lymphoma&#44; and thus avoid under-registering the association between nephropathy and LPL&#46;</p><p class="elsevierStylePara">Additionally&#44; renal biopsies in these patients will facilitate a rapid diagnosis and early start of chemotherapy&#44; which is a key factor in the renal recovery of patients with oncohaematological diseases&#46;</p><p class="elsevierStylePara">Based on these conclusions&#44; the relevance of analysing renal function and the urine sediment in the follow-up of patients with lymphoma is highlighted&#44; as well as cooperation with pathologists&#44; allowing for a clinical-pathological partnership throughout the evolution of this disease&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24595&#95;en&#95;fig&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24595_en_fig_1.jpg" alt="Proliferative glomerulonephritis with a mesangiocapillary pattern"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Proliferative glomerulonephritis with a mesangiocapillary pattern</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24596&#95;en&#95;f2&#95;a&#95;y&#95;b&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24596_en_f2_a_y_b.jpg" alt="A&#58; dense lymphocyte infiltration by B-lymphocytes compatible with B-cell lymphoma &#40;haematoxylin-eosin&#41;&#46; B&#58; immunohistochemistry confirmed the diagnosis of lymphoplasmacytic lymphoma&#44; and the figure shows the positive CD20 staining"></img></a></p><p class="elsevierStylePara">Figure 2&#46; A&#58; dense lymphocyte infiltration by B-lymphocytes compatible with B-cell lymphoma &#40;haematoxylin-eosin&#41;&#46; B&#58; immunohistochemistry confirmed the diagnosis of lymphoplasmacytic lymphoma&#44; and the figure shows the positive CD20 staining</p><p class="elsevierStylePara"><a href="grande&#47;10965&#95;108&#95;24597&#95;en&#95;f3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10965_108_24597_en_f3.jpg" alt="Schematic of the clinical progression &#40;follow-up over 10 years&#41; from the start of cutaneous vasculitis from cryoglobulins to the diagnosis and treatment of lymphoplasmacytic lymphoma"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Schematic of the clinical progression &#40;follow-up over 10 years&#41; from the start of cutaneous vasculitis from cryoglobulins to the diagnosis and treatment of lymphoplasmacytic lymphoma</p>"
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        "resumen" => "<p class="elsevierStylePara">La afectaci&#243;n renal asociada a linfoma es un fen&#243;meno conocido pero frecuentemente no caracterizado debido a la baja frecuencia con que se realizan biopsias en estos pacientes&#46; Varios patrones histol&#243;gicos pueden coexistir y pasar desapercibidos sin un estudio histopatol&#243;gico&#46; La infiltraci&#243;n parenquimatosa renal por linfoma no es infrecuente&#44; y se ha encontrado hasta en un 34&#37; &#40;<span class="elsevierStyleItalic">post mortem</span>&#41; y 14&#37; &#40;<span class="elsevierStyleItalic">pre mortem</span>&#41;&#44; aunque tiene una baja incidencia de manifestaciones cl&#237;nicas&#46;&#160;Existen diferentes patrones de lesi&#243;n renal asociados a linfoma y destaca la asociaci&#243;n de&#160;enfermedad de cambios m&#237;nimos con linfoma&#160; de Hodgkin&#46; La afectaci&#243;n&#160;renal asociada a paraprote&#237;nas sintetizadas por un linfoma&#160;linfoplasmocitario es una asociaci&#243;n excepcional pese a que existen un&#160;20&#37; de pacientes afectados por dichos linfomas que&#160;presentan crioglobulinemia&#46; En la literatura&#160;se han publicado&#160;casos&#160;de enfermedad de cadenas ligeras&#44; amiloidosis&#44; glomerulonefritis inmunotactoide como causas de paraproteinemia&#44; proteinuria e insuficiencia renal en pacientes con linfoma&#46; Presentamos un caso de asociaci&#243;n entre paraproteinemia&#44; glomerulonefritis membrano-proliferativa y la aparici&#243;n cl&#237;nicamente evidente de un linfoma linfoplasmocitario en ausencia de infecci&#243;n por virus de la hepatitis C&#46; Esto demuestra la afectaci&#243;n&#160;polimorfa que pueden presentar los linfomas en el ri&#241;&#243;n y el valor de la nefropatolog&#237;a en el diagn&#243;stico y pron&#243;stico de las enfermedades hematol&#243;gicas que cursan con paraproteinemia&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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2024 September 58 25 83
2024 August 68 70 138
2024 July 52 31 83
2024 June 62 40 102
2024 May 74 44 118
2024 April 65 24 89
2024 March 41 26 67
2024 February 44 35 79
2024 January 68 25 93
2023 December 46 27 73
2023 November 62 32 94
2023 October 53 29 82
2023 September 78 37 115
2023 August 49 13 62
2023 July 37 24 61
2023 June 53 20 73
2023 May 55 30 85
2023 April 49 15 64
2023 March 61 24 85
2023 February 39 20 59
2023 January 47 17 64
2022 December 67 26 93
2022 November 37 32 69
2022 October 52 44 96
2022 September 60 40 100
2022 August 46 38 84
2022 July 40 48 88
2022 June 50 38 88
2022 May 49 35 84
2022 April 71 50 121
2022 March 53 49 102
2022 February 61 45 106
2022 January 77 34 111
2021 December 61 50 111
2021 November 80 37 117
2021 October 56 52 108
2021 September 49 40 89
2021 August 47 35 82
2021 July 45 32 77
2021 June 35 27 62
2021 May 75 42 117
2021 April 119 59 178
2021 March 60 30 90
2021 February 55 13 68
2021 January 57 24 81
2020 December 46 13 59
2020 November 50 20 70
2020 October 37 19 56
2020 September 34 8 42
2020 August 33 13 46
2020 July 43 7 50
2020 June 29 16 45
2020 May 44 10 54
2020 April 38 16 54
2020 March 30 15 45
2020 February 39 21 60
2020 January 37 23 60
2019 December 34 19 53
2019 November 25 15 40
2019 October 16 11 27
2019 September 32 23 55
2019 August 15 14 29
2019 July 25 27 52
2019 June 34 10 44
2019 May 25 11 36
2019 April 65 36 101
2019 March 35 22 57
2019 February 25 17 42
2019 January 31 13 44
2018 December 129 39 168
2018 November 144 18 162
2018 October 183 12 195
2018 September 98 27 125
2018 August 78 18 96
2018 July 60 13 73
2018 June 44 11 55
2018 May 65 10 75
2018 April 96 10 106
2018 March 62 14 76
2018 February 83 7 90
2018 January 55 7 62
2017 December 100 10 110
2017 November 55 5 60
2017 October 52 6 58
2017 September 37 9 46
2017 August 33 11 44
2017 July 55 17 72
2017 June 50 15 65
2017 May 50 13 63
2017 April 46 11 57
2017 March 53 9 62
2017 February 99 5 104
2017 January 66 8 74
2016 December 64 3 67
2016 November 112 9 121
2016 October 163 10 173
2016 September 235 4 239
2016 August 257 9 266
2016 July 188 6 194
2016 June 144 0 144
2016 May 126 0 126
2016 April 101 0 101
2016 March 97 0 97
2016 February 101 0 101
2016 January 103 0 103
2015 December 96 0 96
2015 November 92 0 92
2015 October 102 0 102
2015 September 93 0 93
2015 August 85 0 85
2015 July 87 0 87
2015 June 50 0 50
2015 May 78 0 78
2015 April 6 0 6
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?