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Abstract: TH-PO434

Importance of Monoclonal Gammopathy of Undetermined Significance (MGUS) Surveillance and Difficulty in Diagnosing Monoclonal Gammopathy of Renal Significance (MGRS) in Low-Grade Lymphomas

Session Information

Category: Glomerular Diseases

  • 1301 Glomerular Diseases: Fibrosis and Extracellular Matrix

Authors

  • Abid, Sidrah, Albany Medical Center, Albany, New York, United States
  • Hongalgi, Krishnakumar D., Albany Medical Center, Albany, New York, United States
  • Beers, Kelly H., Albany Medical Center, Albany, New York, United States
  • Mehta, Swati, Albany Medical Center, Albany, New York, United States
Introduction

Mantle cell lymphoma is considered a benign pathology rarely warranting treatment in an indolent phase. Immunoglobulin (Ig) deposition without clinically evident decline in kidney function is referred to as monoclonal gammopathy of unknown significance (MGUS). However, undetected kidney involvement could manifest as renal failure and multi-organ failure.

Case Description

A 49-year-old male with past medical history of untreated indolent mantle cell lymphoma was admitted to the hospital with hypoxic respiratory failure, pulmonary hemorrhage, purpuric lower extremity rash and acute kidney failure requiring hemodialysis. Patient’s creatinine in 2018 was 1.24mg/dl corresponding to eGFR > 60ml/min/m2. Patient had a bone marrow biopsy in 2018 confirming mantle cell lymphoma but as per oncology it did not warrant treatment and his kidney function was not monitored. During the hospitalization, patient was non-oliguric. Creatinine was initially 1.98mg/dl then increased to a peak of 6.82mg/dL. Workup revealed non-nephrotic proteinuria, elevated rheumatoid factor, and low complement levels. Kidney biopsy showed membranoproliferative glomerulonephritis with IgM and C3 deposition on immunofluorescence and no evidence of vasculitis. Patient was diagnosed with cryoglobulinemia-associated glomerulonephritis.
Our patient was treated with a combination of plasmapheresis, high dose glucocorticoids and IV immunoglobulins, but failed to improve. He was eventually started on chemotherapy including cyclophosphamide, rituximab, and vincristine. Patient was on kidney replacement therapy for several weeks then recovered renal function. He was in remission for several weeks but unfortunately expired after an episode of cardiac arrest secondary to severe anemia.

Discussion

Monoclonal gammopathy of renal significance (MGRS) in a smoldering or low-grade lymphoma needs close monitoring of renal function and clonal proliferation with close collaboration with oncology, nephrology and pathology. Our case demonstrates the importance of early detection and treatment.