A 66-year-old woman with nephrotic syndrome and an IgM monoclonal gammopathy

Abstract

Presentation of caseIn September 1996, a 66-year-old woman visited our clinic because of edema of the legs of 4 month's duration. Her family doctor reported a high erythrocyte sedimentation rate of 136 mm in the first hour, marked proteinuria, and the presence of a monoclonal band on serum electrophoresis. In March of the same year she had undergone a total abdominal hysterectomy for a myoma with bilateral salpingo-oophorectomy. Her medical history was otherwise unremarkable.In addition to her edema, which was treated successfully with diuretics, she complained of breathlessness on exertion and lethargy. She did not have any other complaints, in particular, no cardiorespiratory symptoms, periorbital edema, night sweats, or weight loss. Medication consisted of amiloride/hydrochlorthiazide (2.5 mg/25 mg daily) and, until 4 months prior to admission, ibuprofen (400 mg pro re nata) for ill-defined pain in both legs. She did not smoke and only sporadically drank alcohol.On physical examination she appeared well, with a blood pressure of 110/75 mm Hg, a regular pulse rate of 80 beats per minute, weight 69 kg, height 165 cm. There were no abnormal findings; there was neither superficial lymphadenopathy nor hepatosplenomegaly, the kidneys were not palpable, and there was only a mild edema of the feet. Laboratory studies: erythrocyte sedimentation rate (ESR) was 77 mm in the first hour, hemoglobin 9.4 mmol/l with normal cellular indices, white blood cell count (WBC) 8.7!

Therapeutic Apheresis for the Renal Complications of Multiple Myeloma and the Dysglobulinemias

“…In this case, PE and cytotoxic drugs allowed the discontinuation of hemodialysis (42). Nephrotic syndrome with significant albuminuria also may result from amyloidosis (43,44). Gertz et al reported on 50 cases of IgM monoclonal gammopathy and biopsy proven amyloidosis in which 32% had renal involvement (43).…”

Therapeutic Apheresis for the Renal Complications of Multiple Myeloma and the Dysglobulinemias

“…In this case, PE and cytotoxic drugs allowed the discontinuation of hemodialysis (42). Nephrotic syndrome with significant albuminuria also may result from amyloidosis (43,44). Gertz et al reported on 50 cases of IgM monoclonal gammopathy and biopsy proven amyloidosis in which 32% had renal involvement (43).…”

Nephrotic syndrome in a patient with IgM myeloma with associated neutrophilia

“…Light chain deposition disease is another frequent complication of monoclonal gammopathies (22), although infrequently associated with IgM monoclonal gammopathies. Other causes of nephrotic syndrome (23) occasionally reported with IgM monoclonal gammopathies are minimal change nephrotic syndrome, anti‐GMB antibody‐induced glomerulonephritis, immune complex‐mediated glomerulonephritis, and membranous nephropathy.…”