Acute Renal Failure due to IgM-λ Glomerular Thrombi and MPGN-Like Lesions in a Patient With Angioimmunoblastic T-Cell Lymphoma

Renal Lesions Associated with IgM-Secreting Monoclonal Proliferations

“…Intracapillary deposits were absent or sparse. MPGN was not described in the first study of 16 cases of WM kidney (3), but it has since been reported, with or without cryoglobulinemia (22)(23)(24). Of note, Miura et al (22) showed numerous thrombi in the glomerular capillary lumen in a patient with an IgM cryoglobulinemia, but lesions were very suggestive of MPGN with lobular formation and double contour.…”

“…MPGN was not described in the first study of 16 cases of WM kidney (3), but it has since been reported, with or without cryoglobulinemia (22)(23)(24). Of note, Miura et al (22) showed numerous thrombi in the glomerular capillary lumen in a patient with an IgM cryoglobulinemia, but lesions were very suggestive of MPGN with lobular formation and double contour. This observation suggests that overlapping forms between ICMDD and MPGN may occur, most likely depending on the functional or biochemical properties of the monoclonal IgM and the inflammatory response in the patients' glomeruli AL-amyloidosis is now a widely recognized complication of WM.…”

A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy

“…In terms of light chains, positive staining of k light chain and negative staining of k light chain proved the monoclonality. It has been observed in previous studies that multiple immunoglobulins showed positive staining even if a patient had monoclonal immunoglobulin [6,8]. The authors assumed that the reasons why other immunoglobulins stained positive in thrombi might be either the trapping of immunoglobulins and complement or local immune activation [8].…”

“…As for ARF in type I CG, a few cases of both Waldenström's macroglobulinemia and angioimmunoblastic T cell lymphoma containing monoclonal IgM cryoglobulin have been documented [6,7]. Moreover, it is well known that monoclonal IgM in Waldenström's macroglobulinemia per se causes thrombosis, even if cryoglobulin is negative [8].…”

“…However, ARF in type I CG is a rare entity [6,7] and, furthermore, ARF with thrombotic microangiopathy (TMA) (excluding the druginduced type and anti-phospholipid antibody syndrome) has not yet been described.…”