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Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2015 Nov; Vol. 66 (5), pp. 756-67. Date of Electronic Publication: 2015 May 16. - Publication Year :
- 2015
-
Abstract
- Background: Kidney diseases associated with immunoglobulin M (IgM) monoclonal gammopathy are poorly described, with few data for patient outcomes and renal response.<br />Study Design: Case series.<br />Setting & Participants: 35 patients from 8 French departments of nephrology were retrospectively studied. Inclusion criteria were: (1) detectable serum monoclonal IgM, (2) estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m(2) and/or proteinuria with protein excretion > 0.5g/d and/or microscopic hematuria, and (3) kidney biopsy showing monoclonal immunoglobulin deposits and/or lymphomatous B-cell renal infiltration. All patients received chemotherapy, including rituximab-based regimens in 8 cases.<br />Predictors: Patients were classified into 3 groups according to renal pathology: glomerular AL amyloidosis (group 1; n=11), nonamyloid glomerulopathies (group 2; n=15, including 9 patients with membranoproliferative glomerulonephritis), and tubulointerstitial nephropathies (group 3; n=9, including cast nephropathy in 5, light-chain Fanconi syndrome in 3, and isolated tumor infiltration in 1).<br />Outcomes: Posttreatment hematologic response (≥50% reduction in serum monoclonal IgM and/or free light chain level) and renal response (≥50% reduction in 24-hour proteinuria or eGFR≥30mL/min/1.73m(2) in patients with glomerular and tubulointerstitial disorders, respectively).<br />Results: Nephrotic syndrome was observed in 11 and 6 patients in groups 1 and 2, respectively. Patients in group 3 presented with acute kidney injury (n=7) and/or proximal tubular dysfunction (n=3). Waldenström macroglobulinemia was present in 26 patients (8, 12, and 6 in groups 1, 2, and 3, respectively). Significant lymphomatous interstitial infiltration was observed in 18 patients (4, 9, and 5 patients, respectively). Only 9 of 29 evaluable patients had systemic signs of symptomatic hematologic disease (2, 5, and 2, respectively). In groups 1, 2, and 3, respectively, hematologic response was achieved after first-line treatment in 3 of 9, 9 of 10, and 5 of 6 evaluable patients, while renal response occurred in 5 of 10, 9 of 15, and 5 of 8 evaluable patients.<br />Limitations: Retrospective study; insufficient population to establish the impact of chemotherapy.<br />Conclusions: IgM monoclonal gammopathy is associated with a wide spectrum of renal manifestations, with an under-recognized frequency of tubulointerstitial disorders.<br /> (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Kidney Injury etiology
Acute Kidney Injury immunology
Acute Kidney Injury pathology
Adult
Aged
Aged, 80 and over
Amyloid immunology
Amyloidosis etiology
Amyloidosis immunology
Amyloidosis pathology
Antibodies, Monoclonal immunology
Cohort Studies
Female
Glomerulonephritis, Membranoproliferative etiology
Glomerulonephritis, Membranoproliferative immunology
Glomerulonephritis, Membranoproliferative pathology
Humans
Kidney Diseases immunology
Kidney Diseases pathology
Kidney Neoplasms immunology
Kidney Neoplasms pathology
Lymphoma, B-Cell immunology
Lymphoma, B-Cell pathology
Lymphoproliferative Disorders complications
Lymphoproliferative Disorders immunology
Male
Middle Aged
Nephritis, Interstitial etiology
Nephritis, Interstitial immunology
Nephritis, Interstitial pathology
Nephrotic Syndrome etiology
Nephrotic Syndrome immunology
Nephrotic Syndrome pathology
Paraproteinemias immunology
Paraproteinemias pathology
Retrospective Studies
Waldenstrom Macroglobulinemia immunology
Waldenstrom Macroglobulinemia pathology
B-Lymphocytes immunology
Immunoglobulin M immunology
Kidney Diseases etiology
Kidney Neoplasms complications
Lymphoma, B-Cell complications
Paraproteinemias complications
Waldenstrom Macroglobulinemia complications
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 66
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 25987261
- Full Text :
- https://doi.org/10.1053/j.ajkd.2015.03.035