Kidney fouling during CLL watch and wait

[PhotonPal]

This is a bit of a geeky question. I'd like to know the mechanism behind CLL causing the kidney to start plugging up with protein, leading to elevated creatinine that went from 1 to 2 since diagnosis with CLL, before starting treatment (which was triggered by anemia). Doctors told me that the protein may be antibodies shed by CLL cells due to a mutation (it's not normal for CLL to shed antibodies, but this mutation sometimes occurs). My absolute lymphocyte count has ranged between 10 and 19K/uL since diagnosis in 2017. With that fairly low 'tumor load' what else could account for plugging of kidneys?

I did start first-line treatment about a month ago with my first obinutuzumab infusion, but had to pause the regimen for hospitalization for neutropenic fever, but I'm recovered now and my creatinine has dropped significantly, perhaps in proportion to the killing off of CLL cells (my ALC dropped from 13K/uL to 0.9 a few days after the infusion, and a few weeks later it's plateaued (for now) at 3.

Thanks for any ideas on what can cause kidney burden before therapy, even with a fairly low lymphocyte count.

Paul

[Jm954 Administrator]

Hi Paul,

I'm not sure what could have caused this but CLL never fails to surprise us in so many ways.

The good thing is that you are on your way to being well again and your creatinine has fallen.

best wishes

Jackie

[PhotonPal in reply to Jm954]

Thanks Jackie.

[MsLockYourPosts Passed Volunteer]

Do you have a nephrologist on your team? If not, I would look for one who is aware of connections between CLL and the kidneys.

[PhotonPal in reply to MsLockYourPosts]

Yes, thanks for the tip. I have access to a good nephrologist at Stanford Medical Center that is very dialed into the ways blood cancers impact the kidneys.

Paul

[Teddo in reply to PhotonPal]

Dx'd almost 6 yrs ago, ALC at 65 k, in w + w. Age 74 and creatinine has been above range for several yrs after CLL dx, now runs at about 1.4 over the past several readings, enough to lower the eGFR reading into Chronic Kidney disease, stage 3. My PCP, a gerontologist, does not see it related to CLL, rather to aging, something he sees in many of his pts as they age. Other things he looks at re: kidney functioning, such as BUN/creatinine ratio, protein and calcium levels are all in normal range. Am in the Natural History study at NIH where I am seen annually. The doc there likewise did not see elevated creatinine at my level as being CLL related. I would be interested in hearing what your nephrologist says.

[PhotonPal in reply to Teddo]

Hi Teddo,

Thanks for your reply, glad to hear there's an aging component. Thanks for the tip on BUN/creatinine ratio. I calculated mine and it's a bit high. I'm between nephrologists. Interestingly, the nephrology center I want to get into has been closed dues to Covid and they're yet to set up vidio visits.

paul

[Jemorgen]

Hi Paul - thanks for posting this question. I'm curious also as I am recently out of remission (if I ever achieved it as it was less than 6 months). I have SLL and my blood has typically always been normal. With my latest onset of symptoms, I have had increased creatinine, lower GFR (now 61 and it's never been below 80), as well as elevated liver enzymes. I'm 56 so I don't see that aging is particularly a factor. Up until my diagnosis in 2018 I was very healthy and active. I have a PET scan tomorrow with a follow up appt Aug 18 so I'll be interested to see if anything shows up but in the meantime, I'm curious about the liver and kidney involvement.

Heather (Canada)

[PhotonPal]

Jemorgen, thanks for your comment and all the best to you with your PET scan and sorting out what's happening. I'm new to treatment and my first infusion of obinutuzumab really taught me how we can't predict outcomes with perfect confidence. Not like an engineering project, where we can build in safety margins on everything (and even then bridges collapse sometimes).

Paul