title: 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.affiliation: Division of Nephrology and Hypertension, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, USA.
authors.forename: Aisha
authors.initials: A
authors.lastname: Shaikh
authors.affiliation: Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fidler
authors.affiliation: Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, USA. leung.nelson@mayo.edu.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D003449:Cryoglobulinemia / Q000139:chemically induced* / Q000150:complications*; D003450:Cryoglobulins / Q000378:metabolism; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D000069283:Rituximab; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D003450:Cryoglobulins; D007155:Immunologic Factors; D000069283:Rituximab