Renal lesions associated with IgM-secreting monoclonal proliferations: revisiting the disease spectrum.
OBJECTIVE
Since the first description of pathology of the kidney in Waldenström disease in 1970, there have been few reports on kidney complications of IgM-secreting monoclonal proliferations. Here, we aimed to revisit the spectrum of renal lesions occurring in patients with a serum monoclonal IgM.


METHODS
Fourteen patients with a circulating monoclonal IgM and a kidney disease related to B cell proliferation were identified retrospectively. Demographic, clinical, and laboratory data were assessed for each patient at the time of kidney biopsy.


RESULTS
Seven patients had a nephrotic syndrome. Patients without nephrotic syndrome all had impaired renal function. Mean serum creatinine was 238 micromol/L. For five patients, the diagnosis of monoclonal IgM preceded the kidney disease by 28.8 mo (range 12 to 60). Seven patients had Waldenström disease, two had a small B cell non-Hodgkin lymphoma, one had an IgM-excreting multiple myeloma, one had a marginal zone B cell lymphoma, and three had an IgM-related disorder. Renal lesions included (1) intracapillary monoclonal deposits disease with granular, electron-dense IgM thrombi occluding capillary lumens (5); (2) atypical membranoproliferative glomerulonephritis (3); (3) lambda light chain amyloidosis (2) associated with mu deposits in one patient; (4) acute tubular necrosis (1); and (5) CD20(+) lymphomatous infiltration (3). Remission of the nephrotic syndrome was attained in three of seven patients, and renal function improved after chemotherapy.


CONCLUSIONS
Although renal complications of IgM proliferations are rare, a wide spectrum of kidney lesions is observed, without correlation with the type of hematologic disorder.
Audard
Vincent
V
Nephrology and Renal Transplantation Department, Hôpital Henri Mondor, Institut Francilien de recherche en Néphrologie et Transplantation, INSERM U841, University of Paris 12, Créteil, France. vincent.audard@hmn.aphp.fr
Georges
Benoit
B
Vanhille
Philippe
P
Toly
Cécile
C
Deroure
Benjamin
B
Fakhouri
Fadi
F
Cuvelier
René
R
Belenfant
Xavier
X
Surin
Brigitte
B
Aucouturier
Pierre
P
Mougenot
Béatrice
B
Ronco
Pierre
P
D000368:Aged; D000686:Amyloidosis / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000032:analysis*; D001402:B-Lymphocytes / Q000276:immunology* / Q000473:pathology; D049109:Cell Proliferation; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis*; D007674:Kidney Diseases / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D016393:Lymphoma, B-Cell / Q000276:immunology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology; D009404:Nephrotic Syndrome / Q000276:immunology; D012189:Retrospective Studies; D016896:Treatment Outcome; D008258:Waldenstrom Macroglobulinemia / Q000276:immunology
D000911:Antibodies, Monoclonal; D007075:Immunoglobulin M