WHICH TWO KIDNEY BIOPSY FINDINGS ARE MOST ASSOCIATED WITH CLINICAL FINDINGS OF CLL?
Da’as et al describe cases of biopsy proven glomerular diseases in patients with lymphocytic leukemia and or non Hodgkin’s lymphoma. They found 42 cases of glomerular diseases with CLL. The most common glomerular lesion was MPGN(35.7%). The second most common lesion was MN(19%). Recently, an association between MPGN and monoclonal gammopathy of uncertain significance (MGUS) has been reported. Sixteen of 28 patients with monoclonal gammopathy had a normal bone marrow biopsy and were classified as having MGUS. Renal biopsy, however, showed granular immune deposits which correlated with serum or urine monoclonal proteins. This study also showed that MPGN with monoclonal gammopathy can be seen in the setting of other lymphoplasmacytic diseases, including low-grade B-cell lymphoma, CLL, and multiple myeloma. MPGN diagnosis might be the first sign of a forthcoming lymphoplasmacytic malignancy. Recent studies have noted that Immunotactoid GN (ITG) tends to occur at an older age and maybe associated with lymphoproliferative disorder and malignancies, typically paraproteinemias or CLL. Compared to ITG, fibrillary GN is not as strongly associated with neoplasms. So, given above findings, most likely findings would be MPGN, and Immunotactoid GN. Membranous GN would be correct but was not an option. Proliferative and fibrillary are less likely as is tubular interstitial disease.