Cryoglobulinemic membranoproliferative glomerulonephritis associated with mucosaassociated lymphoid tissue lymphoma treated with rituximab

Abstract

Cryoglobulinemia and mucosa-associated lymphoid tissue (MALT) lymphoma are diseases characterized by B-cell dysregulation and overproduction of antibodies. Vasculitis and cutaneous manifestations are common, but renal involvement is rare. A 65-year-old woman with type 1 cryoglobulinemia and MALT lymphomas of the right lacrimal and parotid glands successfully treated by excision and chemoradiotherapy, presented with dyspnea on exertion, edema, and hematuria. Renal biopsy findings revealed type 1 cryoglobulinemic glomerulonephritis. She underwent treatment with high-dose oral prednisone and intravenous rituximab with subsequent return of creatinine to baseline levels. To our knowledge, this is the first report of a patient in whom type 1 cryoglobulinemia, multiple MALT lymphomas, and MPGN with IgM cryoglobulin deposits coexist. Evidence for rituximab is sparse with widely varying protocols and mixed results. There is a need for high quality evidence in the treatment of these conditions.

Type II Cryoglobulinemic Membranoproliferative Glomerulonephritis Caused by Mucosa-associated Lymphoid Tissue Lymphoma

“…MALT lymphoma is a relatively rare subtype of NHL, commonly involving monoclonal IgM production; kidney involvement is less common (9). Very few similar cases have been reported (5,11,14); therefore, the present case is extremely rare.…”

“…This phenomenon (masked monotypic Ig deposits) has been reported in patients with MPGN associated with hematological malignancies ( 17 ). Concurrent glomerulonephritis and direct renal involvement of lymphoma has also been reported ( 11 , 18 ). Treatments for patients with type II CV underlying overt hematologic malignancy should address the underlying hematologic malignancy.…”

“…We herein report an extremely rare case of MALT lymphoma with renal involvement, a rare cause of type II CV ( 4 , 5 ) associated with MPGN ( 11 , 12 ).…”

Acute Kidney Injury in a Patient With Cryoglobulinemia Secondary to Hepatic Mucosa-Associated Lymphoid Tissue Lymphoma: Case Report and Literature Review

“…Estimated glomerular filtration rate also improved from 25 mL/min to 61 mL/min. Several cases of biopsy-proven cryoglobulinemic MPGN associated with MALT lymphoma have been described and authors noted similar recovery rates of renal function, although over a longer four-week hospital course [ 16 , 17 ]. The faster rate of recovery of renal function is the second reason why tubular obstruction can be considered as the cause of AKI.…”