Cast nephropathy: an extremely rare renal presentation of Waldenström's macroglobulinaemia.

Abstract

Renal involvement in Waldenström's macroglobulinaemia (WM) is very unusual when compared to multiple myeloma. We report a case of a patient who developed anuric acute kidney injury secondary to cast nephropathy, dependent on high-flux haemodialysis. Complementary study revealed the presence of blood IgM monoclonal gammopathy and a massive bone marrow lymphoplasmacytic infiltration. There were no osteolytic lesions and no clinical signs/symptoms of hyperviscosity syndrome. The diagnosis of WM was established and a dexamethasone plus cyclophosphamide regime was started, in addition to plasmapheresis. The patient partially recovered renal function allowing haemodialysis and plasmapheresis withdrawal. He remained asymptomatic with a good response to chemotherapy and 12 months after his renal function remained stable. This is a rare clinical case in which WM presented as an IgM cast nephropathy, which in turn is an extremely rare renal presentation of this equally rare haematological disorder.

• Authors: Tânia Santos, Susana Machado, Vítor Sousa, Mário Campos
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2015 (Oct 07 2015) ISSN: 1757-790X [Electronic] England
• PMID: 26446315 (Publication Type: Case Reports, Journal Article)
• Copyright: 2015 BMJ Publishing Group Ltd.

Topics

• Aged, 80 and over
• Anuria (diagnosis, metabolism)
• Humans
• Kidney Diseases (diagnosis, metabolism, pathology)
• Male
• Rare Diseases
• Waldenstrom Macroglobulinemia (diagnosis, metabolism, pathology)