Acute renal failure secondary to severe type I cryoglobulinemia following rituximab therapy for Waldenström's macroglobulinemia.

Abstract

Waldenström's macroglobulinemia is rare lymphoproliferative disorder characterized by the presence of a monoclonal IgM paraproteinemia. Cryoglobulinemia is a common sequela of Waldenström's macroglobulinemia present in 8-18% of the patients. Cryoglobulinemia has also been described as occurring after treatment with rituximab. In the previous report, the cryoglobulinemia was a transient phenomenon and did not carry any adverse effect. We present a case of an 80-year-old male with Waldenström's macroglobulinemia in whom the rituximab-induced cryoglobulinemia resulted in acute renal failure and a vasculitic rash. Cryoglobulins level reached a peak of 63%. The patient was successfully treated with plasmapheresis, chlorambucil and prednisone, with near-complete recovery of renal function. As this case illustrates, the rituximab-induced cryoglobulin is not always benign. Pre- and post-treatment monitoring of the cryoglobulin level is advised in these patients.

• Authors: Aisha Shaikh, Thomas M Habermann, Mary E Fidler, Shaji Kumar, Nelson Leung
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 12 Issue 4 Pg. 292-295 (Aug 2008) ISSN: 1342-1751 [Print] Japan
• PMID: 18288560 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Cryoglobulins
• Immunologic Factors
• Rituximab

Topics

• Acute Kidney Injury (diagnosis, etiology)
• Aged, 80 and over
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Cryoglobulinemia (chemically induced, complications)
• Cryoglobulins (metabolism)
• Humans
• Immunologic Factors (adverse effects, therapeutic use)
• Kidney Glomerulus (pathology)
• Male
• Rituximab
• Waldenstrom Macroglobulinemia (drug therapy)