Abstract: SA-PO211
A Case of Diffuse and Nodular Glomerulosclerosis in Waldenstrom’s Macroglobulinemia
Session Information
- Trainee Case Reports - V
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1201 Glomerular Diseases: Fibrosis and Extracellular Matrix
Authors
- Ehren, Lindsey, University of South Florida, Tampa, Florida, United States
- Lee, Dae Hyun, University of South Florida, Tampa, Florida, United States
- Radoianu, Nicoleta, University of South Florida, Tampa, Florida, United States
- Kumar, Abhishek M., University of South Florida College of Medicine, New Port Richey, Florida, United States
- Bassil, Claude, University of South Florida, Tampa, Florida, United States
- Fu, Liying, Tampa General Hospital, Tampa, Florida, United States
Introduction
Diffuse and nodular glomerulosclerosis (DNGS) is commonly associated with diabetic nephropathy and occasionally with tobacco users. However, it has also been associated with amyloidosis, cryoglobulinemia, and light-chain deposition disease. To the best of our knowledge, there is no published data on DNGS without light chain deposition in Waldenstrom’s Macroglobulinemia (WM). We present a case of DNGS in a non-diabetic, non-smoker with WM.
Case Description
A 72-year-old male with past medical history of Waldenstrom’s Macroglobulinemia develops worsening renal function after CP-R (cyclophosphamide/ prednisone plus rituximab) treatment with partial remission. He does not have diabetes, hypertension or other comorbidities; he is a non-smoker. He uses minimal NSAIDs and denies recent or prior intravenous contrast use. Two months after completion of CP-R regimen, creatinine started rising from baseline 1.0mg/dL to 2.2mg/dL over two years. Serum IgM decreased from 3414 to 2360 after treatment. Blood glucose, liver function panel, and albumin levels were normal. Renal ultrasound showed normal echogenicity without hydronephrosis. Kidney biopsy showed moderate diffuse and nodular glomerulosclerosis with focal cortical atrophy, hypoperfusion and focal global and segmental glomerulosclerosis and moderate vascular sclerosis. Biopsy showed stronger background staining for kappa light chains compared to lambda light chains, without Randall-type electron dense deposits. There was no evidence of monoclonal immunoglobulin deposition, amyloidosis, light chain tubulopathy or light chain cast nephropathy.
Discussion
Waldenstrom’s Macroglobulinemia is a hematologic malignancy characterized by clonal proliferation of B-lymphocytes producing IgM monoclonal gammopathy secretion. It could involve the kidney through large intracapillary IgM deposition, cryoglobulin or amyloidosis related injury. Per literature review, there are no documented cases of DNGS in a patient with WM without history of diabetes or tobacco use. Further research is required to evaluate the prevalence and mechanism behind the association of DNGS and WM.