Kidney Diseases Associated With Monoclonal Immunoglobulin M–Secreting B-Cell Lymphoproliferative Disorders: A Case Series of 35 Patients

Chauvet, Sophie; Bridoux, Frank; Écotière, Laure; Javaugue, Vincent; Sirac, Christophe; Arnulf, Bertrand; Thierry, Antoine; Quellard, Nathalie; Milin, Serge; Bender, Sébastien; Goujon, Jean-Michel; Jaccard, Arnaud; Fermand, Jean‐Paul; Touchard, Guy

doi:10.1053/j.ajkd.2015.03.035

Cited by 68 publications

(74 citation statements)

References 44 publications

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“…This confirms at a larger scale what was previously published (Audard et al, 2008;Salviani et al, 2014;Chauvet et al, 2015), including AL-amyloidosis, MIDD and LPL infiltration as the most prevalent conditions. In this cohort we found a cumulative incidence of WM-related nephropathy of 5Á1% at 15 years from WM diagnosis.…”

Section: Discussionsupporting

confidence: 91%

Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

et al. 2016

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The incidence and prognostic impact of nephropathy related to Waldenström macroglobulinaemia (WM) is currently unknown. We performed a retrospective study to assess biopsy-confirmed WM-related nephropathy in a cohort of 1391 WM patients seen at a single academic institution. A total of 44 cases were identified, the estimated cumulative incidence was 5·1% at 15 years. There was a wide variation in kidney pathology, some directly related to the WM: amyloidosis (n = 11, 25%), monoclonal-IgM deposition disease/cryoglobulinaemia (n = 10, 23%), lymphoplasmacytic lymphoma infiltration (n = 8, 18%), light-chain deposition disease (n = 4, 9%) and light-chain cast nephropathy (n = 4, 9%), and some probably related to the WM: thrombotic microangiopathy (TMA) (n = 3, 7%), minimal change disease (n = 2, 5%), membranous nephropathy (n = 1, 2%) and crystal-storing tubulopathy (n = 1, 2%). The median overall survival in patients with biopsy-confirmed WM-related nephropathy was 11·5 years, shorter than for the rest of the cohort (16 years, P = 0·03). Survival was better in patients with stable or improved renal function after treatment (P = 0·05). Based on these findings, monitoring for renal disease in WM patients should be considered and a kidney biopsy pursued in those presenting with otherwise unexplained renal failure and/or nephrotic syndrome.

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Section: Discussionsupporting

confidence: 91%

Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

et al. 2016

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“…Our patient had CD5 and CD23 negativity in contrast to B-CLL, which would have both CD5 and CD23 positivity. [9][10][11] The patients may be asymptomatic, and treatment is required only in the symptomatic patients. Patients with WM are candidates for treatment if they have clinical evidence of aggressive disease progression or if they have had clinical and laboratory manifestations associated with WM.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with WM are candidates for treatment if they have clinical evidence of aggressive disease progression or if they have had clinical and laboratory manifestations associated with WM. [11][12] Alexander P et al reported a case of WM where patient presented with bilateral simultaneous central retinal vein occlusion. [3] Similarly, Nayak et al published a case of WM presenting as pancreatic mass.…”

Section: Discussionmentioning

confidence: 99%

Waldenstrom’s Macroglobulinemia Presenting in A Hypertensive Patient

Rahar

Kumar

Kishore

et al. 2018

APALM

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Waldenstrom's macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma. It is characterized by a wide range of clinical presentations related to direct tumor infiltration and the production of IgM. Usually it presents with constitutional symptoms, organomegaly, cytopenias and hyperviscosity syndrome. We report a case of WM in a 75-year-old male who initially presented with only epistaxis and unconsciousness. The patient had no lymphadenopathy or any organomegaly. The diagnosis of WM was made after morphological and immunohistochemical examination of bone marrow of the patient along with an elevated serum IgM level. The patient responded well to chemotherapy. This case is unusual because the patient lacked the common clinical features of WM. This case report discusses wide variety of clinical presentations of WM along with various other lymphoid lesions as differential diagnosis.

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“…A series from Italy found multiple myeloma in 65% of patients and chronic lymphocytic leukemia in 3% of patients (20). However, when myeloma was defined by CRAB, the rate dropped to 20%-22%, suggesting that most of the patients had smoldering multiple myeloma rather than multiple myeloma (19,43). Mortality of these patients is largely dependent on the presence of multiple myeloma.…”

Section: Monoclonal Ig Deposition Diseasementioning

confidence: 99%

“…Two more recent series, however, found that AIg amyloidosis was the most common renal lesion in Waldenström macroglobulinemia. Cryoglobulinemic GN had dropped to second (43,63). Reasons for this are unclear, but kidney biopsy may have been skipped if cryoglobulins were detected in the blood.…”

Section: Lymphoplasmocytic Lymphoma/waldenströ M Macroglobulinemiamentioning

confidence: 99%

Dysproteinemias and Glomerular Disease

Leung

Drosou

Nasr

2017

CJASN

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Dysproteinemia is characterized by the overproduction of an Ig by clonal expansion of cells from the B cell lineage. The resultant monoclonal protein can be composed of the entire Ig or its components. Monoclonal proteins are increasingly recognized as a contributor to kidney disease. They can cause injury in all areas of the kidney, including the glomerular, tubular, and vascular compartments. In the glomerulus, the major mechanism of injury is deposition. Examples of this include Ig amyloidosis, monoclonal Ig deposition disease, immunotactoid glomerulopathy, and cryoglobulinemic GN specifically from types 1 and 2 cryoglobulins. Mechanisms that do not involve Ig deposition include the activation of the complement system, which causes complement deposition in C3 glomerulopathy, and cytokines/growth factors as seen in thrombotic microangiopathy and precipitation, which is involved with cryoglobulinemia. It is important to recognize that nephrotoxic monoclonal proteins can be produced by clones from any of the B cell lineages and that a malignant state is not required for the development of kidney disease. The nephrotoxic clones that do not meet requirement for a malignant condition are now called monoclonal gammopathy of renal significance. Whether it is a malignancy or monoclonal gammopathy of renal significance, preservation of renal function requires substantial reduction of the monoclonal protein. With better understanding of the pathogenesis, clone-directed strategies, such as rituximab against CD20 expressing B cell and bortezomib against plasma cell clones, have been used in the treatment of these diseases. These clone-directed therapies been found to be more effective than immunosuppressive regimens used in nonmonoclonal protein-related kidney diseases.

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Kidney Diseases Associated With Monoclonal Immunoglobulin M–Secreting B-Cell Lymphoproliferative Disorders: A Case Series of 35 Patients

Cited by 68 publications

References 44 publications

Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

Waldenstrom’s Macroglobulinemia Presenting in A Hypertensive Patient

Dysproteinemias and Glomerular Disease

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