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September 1986

Nephrotic Syndrome Associated With a Clonal T-Cell Leukemia of Large Granular Lymphocytes With Cytotoxic Function

Author Affiliations

From the Medical and Laboratory Services, Veterans Administration Medical Center (Drs Orman, Schechter, Guccion, Chan, and Shalhoub); the Departments of Medicine and Pathology of George Washington University (Drs Orman, Schechter, Guccion, Chan, and Schulof); and the Department of Medicine of Georgetown University (Dr Shalhoub), Washington, DC; and the National Cancer Institute, National Institutes of Health, Bethesda, Md (Dr Whang-Peng).

Arch Intern Med. 1986;146(9):1827-1829. doi:10.1001/archinte.1986.00360210223034

• A 51-year-old man presented with a T-cell leukemia of large granular lymphocytes and rapidly developed a nephrotic syndrome due to presumptive minimal-change glomerulopathy. The E-rosette+, la+ cells demonstrated cytotoxic activity similar to that of natural killer lymphocytes but lacked other T-subset markers, except that one third of them bore Fc(IgG) receptors. Cytogenetic analysis revealed loss of chromosome 10 and the translocation (1;10)(p11;q11) in all metaphases. Regression of the leukemia after chemotherapy was accompanied by a dramatic resolution of the nephrotic syndrome, suggesting that the activated granular lymphocytes induced the renal lesion. The close association of a clonal T-lymphoproliferative disorder with minimal-change nephrotic syndrome lends further support to current views implicating activated T cells or their products in the pathogenesis of this glomerulopathy.

(Arch Intern Med 1986;146:1827-1829)

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