PMC10160354_01
Renal histology. PAS-stained renal biopsy. (A) Low magnification shows a dense lymphocytic infiltrate composed of small monotonous lymphocytes in aggregate (black arrow). Scale bar: 100 muM (B) High-magnification highlights renal glomerulus with thickening of the basal membrane (black arrows). Scale bar: 50 muM.
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Histology on 12 glomeruli showed thickening of the glomerular basement membrane with limited CLL infiltrate ( Figures 1A, B ).
Proteinuria time course. Schema of patient's proteinuria in relation to treatments administered. Rituximab was administered at 700 mg each dose. Venetoclax was started according to the standard ramp-up schedule. As evident by the graph, proteinuria had a partially remitting-relapsing course during rituximab treatment, with all values persistently above the nephrotic threshold (dashed line). By contrast, venetoclax led to a rapid and durable reduction of proteinuria that fell below the nephrotic threshold.
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Due to further worsening of nephrotic syndrome, with proteinuria reaching 7 g/24h in June 2019, Rituximab treatment was started ( Figure 2 ). Decline of urinary protein excretion was observed as soon as 12 weeks after venetoclax initiation, with proteinuria falling from 7.21 g/24h (March 2021) to 1.86 g/24h (June 2021) ( Figure 2 ).