Mantle Cell Lymphoma Isn't Just Renal Infiltration
In a paper published in KI Reports, various GNs were reported with Mantle Cell lymphoma. When we think of kidney disease in mantle cell lymphoma (MCL), we often think about direct lymphomatous infiltration. This multicenter series reminds us that immune-mediated glomerular diseases are actually common and frequently improve with lymphoma-directed therapy.
Study Highlights
30 patients with MCL who underwent kidney biopsy from multiple centers.
20 had active MCL at biopsy.
Among those with active disease:
70% had kidney lesions attributable or potentially attributable to MCL.
55% had immune complex (IC) or complement-mediated glomerular disease.
40% had renal lymphomatous infiltration, often coexisting with glomerular lesions.
Interestingly, renal Pathology Was Remarkably Diverse. The spectrum included:
PGNMID (including IgG3κ cases)
C3 glomerulonephritis
Secondary membranous nephropathy
Lupus-like immune complex GN
Tubular basement membrane immune deposits
Concurrent lymphomatous infiltration in many patients.
Perhaps the most important finding: Patients with PGNMID, C3GN, and membranous nephropathy who received lymphoma-directed therapy experienced remission of both their hematologic disease and kidney disease, with marked improvements in creatinine and proteinuria.
Unlike many monoclonal gammopathy-associated kidney diseases, most glomerular lesions were polyclonal rather than monoclonal, suggesting that immune dysregulation and complement activation—rather than direct deposition of a circulating monoclonal protein—may drive kidney injury in MCL.
In summary, Kidney injury in MCL extends far beyond direct lymphoma infiltration. Consider kidney biopsy in MCL patients with AKI, proteinuria, or hematuria. Successful treatment of the lymphoma can result in remission of the glomerular disease, emphasizing the importance of multidisciplinary care between nephrology, pathology, and hematology.
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