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Renal lesions associated with IgM-secreting monoclonal proliferations: revisiting the disease spectrum.

AbstractBACKGROUND AND OBJECTIVES:
Since the first description of pathology of the kidney in Waldenström disease in 1970, there have been few reports on kidney complications of IgM-secreting monoclonal proliferations. Here, we aimed to revisit the spectrum of renal lesions occurring in patients with a serum monoclonal IgM.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
Fourteen patients with a circulating monoclonal IgM and a kidney disease related to B cell proliferation were identified retrospectively. Demographic, clinical, and laboratory data were assessed for each patient at the time of kidney biopsy.
RESULTS:
Seven patients had a nephrotic syndrome. Patients without nephrotic syndrome all had impaired renal function. Mean serum creatinine was 238 micromol/L. For five patients, the diagnosis of monoclonal IgM preceded the kidney disease by 28.8 mo (range 12 to 60). Seven patients had Waldenström disease, two had a small B cell non-Hodgkin lymphoma, one had an IgM-excreting multiple myeloma, one had a marginal zone B cell lymphoma, and three had an IgM-related disorder. Renal lesions included (1) intracapillary monoclonal deposits disease with granular, electron-dense IgM thrombi occluding capillary lumens (5); (2) atypical membranoproliferative glomerulonephritis (3); (3) lambda light chain amyloidosis (2) associated with mu deposits in one patient; (4) acute tubular necrosis (1); and (5) CD20(+) lymphomatous infiltration (3). Remission of the nephrotic syndrome was attained in three of seven patients, and renal function improved after chemotherapy.
CONCLUSIONS:
Although renal complications of IgM proliferations are rare, a wide spectrum of kidney lesions is observed, without correlation with the type of hematologic disorder.
AuthorsVincent Audard, Benoit Georges, Philippe Vanhille, Cécile Toly, Benjamin Deroure, Fadi Fakhouri, René Cuvelier, Xavier Belenfant, Brigitte Surin, Pierre Aucouturier, Béatrice Mougenot, Pierre Ronco
JournalClinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 3 Issue 5 Pg. 1339-49 (Sep 2008) ISSN: 1555-905X [Electronic] United States
PMID18632851 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antibodies, Monoclonal
  • Immunoglobulin M
Topics
  • Aged
  • Amyloidosis (immunology)
  • Antibodies, Monoclonal (analysis)
  • B-Lymphocytes (immunology, pathology)
  • Cell Proliferation
  • Female
  • Glomerulonephritis, Membranoproliferative (immunology)
  • Humans
  • Immunoglobulin M (analysis)
  • Kidney Diseases (drug therapy, immunology, pathology, physiopathology)
  • Lymphoma, B-Cell (immunology)
  • Lymphoma, B-Cell, Marginal Zone (immunology)
  • Lymphoproliferative Disorders (complications, drug therapy, immunology, pathology)
  • Male
  • Middle Aged
  • Multiple Myeloma (immunology)
  • Nephrotic Syndrome (immunology)
  • Retrospective Studies
  • Treatment Outcome
  • Waldenstrom Macroglobulinemia (immunology)

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