Minimal change glomerulonephritis in chronic lymphocytic leukemia: pathophysiological and therapeutic aspects.

BACKGROUND: So far, only 9 cases of minimal change glomerulonephritis (MCGN) related to chronic lymphocytic leukemia (CLL) have been described.

CASE REPORT: Our patient presented with severe nephrotic syndrome. Diagnostic biopsies confirmed MCGN and early-stage BCLL (Binet A). In contrast to previously described cases, kappa monoclonal IgM and cryoglobulins were also detected. The patient was treated with chlorambucil and prednisone. 3 weeks later, renal function and white blood cell (WBC) count were completely normal.

DISCUSSION: Although, in most cases, renal disease and CLL present separately, there is evidence for a causal relationship between the two disorders. Although it is widely approved that early-stage CLL should not be treated by medication, the severe nephrotic syndrome in our patient required immediate intervention. So far, there is no standard therapy for MCGN associated with CLL. Our combination therapy resulted in normalization of the nephrotic syndrome and the WBC count. Hence, we emphasize the importance of early recognition of renal symptoms in CLL and propose a successful therapy for nephrotic syndrome in MCGN associated with early-stage B-CLL. Additionally, the pathophysiological and therapeutic aspects of MCGN associated with CLL are retrospectively discussed.