Membranoproliferative glomerulonephritis complicating Waldenström’s macroglobulinemia

BMC Nephrology

Maike Büttner¹  Heike Bruck²  Kerstin Amann¹  David Kratochvil² 

[1] Institute of Pathology, Department of Nephropathology, University Hospital Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Germany;Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

关键词: Hyaline thrombi;    MPGN;    Waldenström’s macroglobulinemia;   

Others  :  1083040
DOI  :  10.1186/1471-2369-13-172

 received in 2012-07-11, accepted in 2012-12-19,  发布年份 2012

【 摘 要 】

Background

Lymphoproliferative disorders causing paraproteinemia can be associated with various kidney injuries including the deposition of monoclonal immunoglobulins (Ig). A known glomerular manifestation of Waldenström’s macroglobulinemia is characterized by prominent intracapillary hyaline thrombi and lack of conspicuous glomerular proliferation. The present case was special in 2 aspects: 1. the diagnosis of glomerulonephritis was unexpected before renal biopsy, 2. the prominent glomerular proliferation paired with large intracapillary hyaline thrombi is uncommon in Waldenström’s macroglobulinemia-associated glomerulonephritis.

Case presentation

A 73-year-old Caucasian woman with a long-standing history of rheumatoid arthritis and Waldenström’s macroglobulinemia was admitted for acute renal failure (ARF), which initially was presumed to be the consequence of extrarenal causes. Proteinuria and hematuria were only mild. In renal core biopsy, a membranoproliferative glomerulonephritis (MPGN) and prominent intracapillary hyaline monoclonal IgM thrombi were found in addition to acute tubular necrosis. Of note, the patient’s history was positive for purpuric skin changes, suspicious for cryoglobulinemia. However, serological tests for cryoglobulins were repeatedly negative. The ARF resolved before the start of immunomodulatory therapy for Waldenström’s macroglobulinemia.

Conclusion

The presence of MPGN with prominent hyaline thrombi in the context of Waldenström’s macroglobulinemia is uncommon and can be oligosymptomatic. We discuss this case in the context of previous literature and classifications suggested for monoclonal Ig-related renal pathologies.

【 授权许可】

   
2012 Kratochvil et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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