SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Concomitant Chronic Lymphocytic Leukemia (Cll) and Waldenstrom's Macroglobulinemia (Wm) Presenting With Nephrotic Syndrome

A Rare Case of Concomitant Chronic Lymphocytic Leukemia (Cll) and Waldenstrom's Macroglobulinemia (Wm) Presenting With Nephrotic Syndrome

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This case report describes a 53-year-old man with type 1 diabetes and hypertension who developed severe nephrotic syndrome, marked by five weeks of progressive edema, 25-pound weight gain, decreased urine output, 9.75 g/day proteinuria, hypoalbuminemia, and acute kidney injury. Initial outpatient diuretic and kidney-directed therapy provided only temporary relief.<br /><br />Further evaluation revealed an elevated IgM level and an SPEP showing a large IgM spike, raising concern for an underlying hematologic disorder. Kidney biopsy showed glomerular changes consistent with minimal change disease, including podocyte foot process effacement on electron microscopy. Bone marrow biopsy then identified small mature lymphocyte aggregates, and flow cytometry demonstrated two abnormal B-cell populations, confirming concurrent chronic lymphocytic leukemia (CLL) and Waldenström macroglobulinemia (WM).<br /><br />The patient was transferred for oncology management and treated with corticosteroids, plasmapheresis, IV furosemide, and rituximab, followed by zanubrutinib and torsemide at discharge. His renal function improved back to baseline, and he was later taken off zanubrutinib.<br /><br />The report highlights several key points: CLL and WM can be asymptomatic and may rarely present primarily through renal disease; minimal change disease is uncommon in adults and should prompt concern for malignancy; and WM can cause kidney injury through IgM-related glomerular deposits. In adults with nephrotic syndrome, especially when accompanied by abnormal SPEP findings, clinicians should strongly consider hematologic malignancy, involve hematology early, and pursue renal biopsy when appropriate.

Asset Subtitle

Jad Daw

Meta Tag

Author List Candice K. Park, Jad Daw, Phillip Hamilton, Vignesh Doraiswamy

Category Clinical Vignettes

Concept Nephrotic Syndrome

Concept Hematologic Malignancy

Concept Waldenström Macroglobulinemia

Concept Proteinuria

Concept Minimal Change Disease

Distinguished Non-Finalist

Presenter Organization The Ohio State University

Presenting Author Jad Daw

Track Adult

Keywords

nephrotic syndrome

minimal change disease

chronic lymphocytic leukemia

Waldenström macroglobulinemia

IgM spike

proteinuria

kidney biopsy

hematologic malignancy

acute kidney injury

podocyte effacement

Nephrotic Syndrome

Hematologic Malignancy

Waldenström Macroglobulinemia

Proteinuria

Minimal Change Disease