Acute kidney injury due to direct infiltration by lymphoplasmacytic lymphoma secreting IgG paraproteins A case reportopen access
- Authors
- Kim, Seongmin; Bae, Wooram; Choi, Jungyoon; Lee, Tae Won; Song, Dae Hyun; Bae, Eunjin; Jang, Ha Nee; Chang, Se-Ho; Park, Dong Jun
- Issue Date
- 17-Jun-2022
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- acute kidney injury; IgG; LPL; paraprotein; Waldenstrom' s macroglbulinemia
- Citation
- MEDICINE, v.101, no.24, pp.E29449
- Indexed
- SCIE
SCOPUS
- Journal Title
- MEDICINE
- Volume
- 101
- Number
- 24
- Start Page
- E29449
- URI
- https://scholarworks.bwise.kr/gnu/handle/sw.gnu/1160
- DOI
- 10.1097/MD.0000000000029449
- ISSN
- 0025-7974
- Abstract
- Introduction: Waldenstrom's macroglobulinemia is a lymphoplasmacytic lymphoma (LPL) associated with a monoclonal immunoglobulin M protein. Although acute kidney injury (AKI) due to immunoglobulin M paraprotein infiltration into the renal interstitium has been reported, there has been no report of AKI with invasion of the immunoglobulin G paraprotein into the renal interstitium in a patient with LPL. Patient concerns: A 65-year-old male was admitted to our hospital with fatigue and decreased renal function. He complained of a 3-kg weight loss in the last 3 months. Diagnosis: The initial blood urea nitrogen and serum creatinine levels were 55.9 and 1.83 mg/dL, respectively. Serum protein electrophoresis revealed a monoclonal component (3.5 g/dL) in the gamma region and immunofixation electrophoresis showed an immunoglobulin G kappa monoclonal protein. Renal pathology revealed that CD3-CD20+ CD138+ lymphoid cells had infiltrated the renal interstitium. A bone marrow biopsy was compatible with LPL. Interventions: Intravenous methylprednisolone (1 mg/kg) was administered after confirming the renal pathological findings. Outcomes: Serum creatinine decreased to 0.8 mg/dL 14 days after treatment Conclusions: Physicians should recognize LPL secreting various immunoglobulins as a possible cause of AKI when renal failure of unknown etiology and serum immunoglobulin paraprotein is present. A kidney biopsy should be performed for definitive diagnosis and appropriate management.
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