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Renal involvement in Waldenström's macroglobulinemia: case report and review of literature.
[waldenström macroglobulinemia]
Waldenström
's
macroglobulinemia
(
WM
)
is
a
rare
lymphoid
neoplasia
,
accounting
for
2
%
of
all
hematological
malignancies
.
Renal
complications
occur
rather
rarely
compared
to
multiple
myeloma
.
The
most
common
renal
manifestations
are
mild
proteinuria
and
microhematuria
.
We
describe
a
case
of
MW
presenting
with
acute
renal
failure
and
NS
.
A
67
-
year
-old
man
was
referred
to
our
hospital
for
sudden
onset
nephrotic
syndrome
.
Electrophoresis
revealed
a
monoclonal
component
in
the
gamma
region
,
which
was
classified
as
an
IgM
k
.
During
hospitalization
,
acute
kidney
injury
developed
,
with
creatinine
up
to
5
 
mg
/
dL
,
despite
adequate
hydration
and
alkalinization
.
A
kidney
biopsy
was
performed
,
showing
minimal
change
disease
(
MCD
)
with
interstitial
and
capsular
lymphoid
infiltrates
of
B-Lymphocytes
CD
2
0
+
.
B-
lymphocytes
infiltration
suggested
the
possibility
of
renal
localization
of
lymphoproliferative
disorder
.
So
,
bone
marrow
histology
was
performed
,
revealing
lymphoplasmacytic
lymphoma
(
WM
)
.
The
patient
was
treated
with
bortezomib
,
desamethasone
,
and
rituximab
,
with
partial
recovery
of
renal
function
(
creatinine
1
.
5
 
mg
/
dL
)
and
complete
remission
of
proteinuria
after
8
-
month
follow-up
.
The
remission
of
NS
in
our
patient
with
rituximab
seems
to
emphasize
the
pathogenetic
role
of
B
cells
in
MCD
,
although
a
coincident
effect
of
immunosuppression
on
both
the
underlying
renal
disease
and
the
hematologic
disease
can
not
be
excluded
.
Diseases
Validation
Diseases presenting
"renal complications"
symptom
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
fabry disease
familial hypocalciuric hypercalcemia
homocystinuria without methylmalonic aciduria
junctional epidermolysis bullosa
typhoid
waldenström macroglobulinemia
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