Kidney involvement of patients with Waldenström macroglobulinemia and other IgM-producing B cell lymphoproliferative disorders

Larissa Higgins, Samih H. Nasr, Samar M. Said, Prashant Kapoor, David M Dingli, Rebecca King, S Vincent Rajkumar, Robert A. Kyle, Taxiarchis Kourelis, Morie Gertz, Angela Dispenzieri, Martha Lacy, Francis K. Buadi, Stephen Maxted Ansell, Wilson Gonsalves, Carrie A Thompson, Fernando Custodio Fervenza, Ladan Zand, Yi L. Hwa, Dragan JevremovicMin Shi, Nelson Leung

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Abstract

Background and objectives Kidney involvement in Waldenström macroglobulinemia is less well described compared with kidney manifestations in multiple myeloma. Design, setting, participants, & measurements Of the 1363 patients seen with Waldenström macroglobulinemia and other IgM-secreting B cell lymphoproliferative disorders seen at the Mayo Clinic between 1996 and 2015, 57 kidney biopsies were retrospectively studied. The biopsy findings were correlated with clinical, kidney, and hematologic characteristics. Criteria for inclusion were evidence of a monoclonal IgM protein and availability of a kidney and a bone marrow biopsy for review. Glomerular and tubulointerstitial pathologies were categorized according to whether they were related to the monoclonal IgM. Results Of the 57 patients identified, monoclonal gammopathy–related kidney lesions were identified in 82% (47 of 57 biopsies), whereas nonmonoclonal gammopathy–related kidney lesions were seen in 18% (ten of 57). Monoclonal gammopathy–related kidney lesions included monoclonal Ig–related amyloidosis (n=19; 33%), nonamyloid glomerulopathy (n=20, 35%), and tubulointerstitial nephropathies (n=8; 14%). The most common monoclonal gammopathy–related kidney lesion was monoclonal Ig–related amyloidosis (n=19; 33%) followed by cryoglobulinemic GN (n=13; 28%). Lymphoma infiltration was the most common tubulointerstitial lesion (n=4; 9%). The hematologic diagnosis was Waldenström macroglobulinemia in 74% (n=42), monoclonal gammopathy of renal significance in 16% (n=9), and marginal zone lymphoma (n=2), chronic lymphocytic leukemia (n=2), and low-grade B cell lymphoma (n=2) in 4% each. Conclusions Our study confirms a diverse variety of kidney lesions in patients with monoclonal IgM gammopathy.

Original languageEnglish (US)
Pages (from-to)1037-1046
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number7
DOIs
StatePublished - Jul 6 2018

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Waldenstrom Macroglobulinemia
Lymphoproliferative Disorders
Immunoglobulin M
B-Lymphocytes
Kidney
Biopsy
Paraproteinemias
Amyloidosis
Lymphoma
B-Cell Lymphoma
B-Cell Chronic Lymphocytic Leukemia
Multiple Myeloma
Non-Hodgkin's Lymphoma
Bone Marrow

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

@article{372b59926b2948ccaa8fd87d2597e04d,
title = "Kidney involvement of patients with Waldenstr{\"o}m macroglobulinemia and other IgM-producing B cell lymphoproliferative disorders",
abstract = "Background and objectives Kidney involvement in Waldenstr{\"o}m macroglobulinemia is less well described compared with kidney manifestations in multiple myeloma. Design, setting, participants, & measurements Of the 1363 patients seen with Waldenstr{\"o}m macroglobulinemia and other IgM-secreting B cell lymphoproliferative disorders seen at the Mayo Clinic between 1996 and 2015, 57 kidney biopsies were retrospectively studied. The biopsy findings were correlated with clinical, kidney, and hematologic characteristics. Criteria for inclusion were evidence of a monoclonal IgM protein and availability of a kidney and a bone marrow biopsy for review. Glomerular and tubulointerstitial pathologies were categorized according to whether they were related to the monoclonal IgM. Results Of the 57 patients identified, monoclonal gammopathy–related kidney lesions were identified in 82{\%} (47 of 57 biopsies), whereas nonmonoclonal gammopathy–related kidney lesions were seen in 18{\%} (ten of 57). Monoclonal gammopathy–related kidney lesions included monoclonal Ig–related amyloidosis (n=19; 33{\%}), nonamyloid glomerulopathy (n=20, 35{\%}), and tubulointerstitial nephropathies (n=8; 14{\%}). The most common monoclonal gammopathy–related kidney lesion was monoclonal Ig–related amyloidosis (n=19; 33{\%}) followed by cryoglobulinemic GN (n=13; 28{\%}). Lymphoma infiltration was the most common tubulointerstitial lesion (n=4; 9{\%}). The hematologic diagnosis was Waldenstr{\"o}m macroglobulinemia in 74{\%} (n=42), monoclonal gammopathy of renal significance in 16{\%} (n=9), and marginal zone lymphoma (n=2), chronic lymphocytic leukemia (n=2), and low-grade B cell lymphoma (n=2) in 4{\%} each. Conclusions Our study confirms a diverse variety of kidney lesions in patients with monoclonal IgM gammopathy.",
author = "Larissa Higgins and Nasr, {Samih H.} and Said, {Samar M.} and Prashant Kapoor and Dingli, {David M} and Rebecca King and Rajkumar, {S Vincent} and Kyle, {Robert A.} and Taxiarchis Kourelis and Morie Gertz and Angela Dispenzieri and Martha Lacy and Buadi, {Francis K.} and Ansell, {Stephen Maxted} and Wilson Gonsalves and Thompson, {Carrie A} and Fervenza, {Fernando Custodio} and Ladan Zand and Hwa, {Yi L.} and Dragan Jevremovic and Min Shi and Nelson Leung",
year = "2018",
month = "7",
day = "6",
doi = "10.2215/CJN.13041117",
language = "English (US)",
volume = "13",
pages = "1037--1046",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "7",

}

TY - JOUR

T1 - Kidney involvement of patients with Waldenström macroglobulinemia and other IgM-producing B cell lymphoproliferative disorders

AU - Higgins, Larissa

AU - Nasr, Samih H.

AU - Said, Samar M.

AU - Kapoor, Prashant

AU - Dingli, David M

AU - King, Rebecca

AU - Rajkumar, S Vincent

AU - Kyle, Robert A.

AU - Kourelis, Taxiarchis

AU - Gertz, Morie

AU - Dispenzieri, Angela

AU - Lacy, Martha

AU - Buadi, Francis K.

AU - Ansell, Stephen Maxted

AU - Gonsalves, Wilson

AU - Thompson, Carrie A

AU - Fervenza, Fernando Custodio

AU - Zand, Ladan

AU - Hwa, Yi L.

AU - Jevremovic, Dragan

AU - Shi, Min

AU - Leung, Nelson

PY - 2018/7/6

Y1 - 2018/7/6

N2 - Background and objectives Kidney involvement in Waldenström macroglobulinemia is less well described compared with kidney manifestations in multiple myeloma. Design, setting, participants, & measurements Of the 1363 patients seen with Waldenström macroglobulinemia and other IgM-secreting B cell lymphoproliferative disorders seen at the Mayo Clinic between 1996 and 2015, 57 kidney biopsies were retrospectively studied. The biopsy findings were correlated with clinical, kidney, and hematologic characteristics. Criteria for inclusion were evidence of a monoclonal IgM protein and availability of a kidney and a bone marrow biopsy for review. Glomerular and tubulointerstitial pathologies were categorized according to whether they were related to the monoclonal IgM. Results Of the 57 patients identified, monoclonal gammopathy–related kidney lesions were identified in 82% (47 of 57 biopsies), whereas nonmonoclonal gammopathy–related kidney lesions were seen in 18% (ten of 57). Monoclonal gammopathy–related kidney lesions included monoclonal Ig–related amyloidosis (n=19; 33%), nonamyloid glomerulopathy (n=20, 35%), and tubulointerstitial nephropathies (n=8; 14%). The most common monoclonal gammopathy–related kidney lesion was monoclonal Ig–related amyloidosis (n=19; 33%) followed by cryoglobulinemic GN (n=13; 28%). Lymphoma infiltration was the most common tubulointerstitial lesion (n=4; 9%). The hematologic diagnosis was Waldenström macroglobulinemia in 74% (n=42), monoclonal gammopathy of renal significance in 16% (n=9), and marginal zone lymphoma (n=2), chronic lymphocytic leukemia (n=2), and low-grade B cell lymphoma (n=2) in 4% each. Conclusions Our study confirms a diverse variety of kidney lesions in patients with monoclonal IgM gammopathy.

AB - Background and objectives Kidney involvement in Waldenström macroglobulinemia is less well described compared with kidney manifestations in multiple myeloma. Design, setting, participants, & measurements Of the 1363 patients seen with Waldenström macroglobulinemia and other IgM-secreting B cell lymphoproliferative disorders seen at the Mayo Clinic between 1996 and 2015, 57 kidney biopsies were retrospectively studied. The biopsy findings were correlated with clinical, kidney, and hematologic characteristics. Criteria for inclusion were evidence of a monoclonal IgM protein and availability of a kidney and a bone marrow biopsy for review. Glomerular and tubulointerstitial pathologies were categorized according to whether they were related to the monoclonal IgM. Results Of the 57 patients identified, monoclonal gammopathy–related kidney lesions were identified in 82% (47 of 57 biopsies), whereas nonmonoclonal gammopathy–related kidney lesions were seen in 18% (ten of 57). Monoclonal gammopathy–related kidney lesions included monoclonal Ig–related amyloidosis (n=19; 33%), nonamyloid glomerulopathy (n=20, 35%), and tubulointerstitial nephropathies (n=8; 14%). The most common monoclonal gammopathy–related kidney lesion was monoclonal Ig–related amyloidosis (n=19; 33%) followed by cryoglobulinemic GN (n=13; 28%). Lymphoma infiltration was the most common tubulointerstitial lesion (n=4; 9%). The hematologic diagnosis was Waldenström macroglobulinemia in 74% (n=42), monoclonal gammopathy of renal significance in 16% (n=9), and marginal zone lymphoma (n=2), chronic lymphocytic leukemia (n=2), and low-grade B cell lymphoma (n=2) in 4% each. Conclusions Our study confirms a diverse variety of kidney lesions in patients with monoclonal IgM gammopathy.

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U2 - 10.2215/CJN.13041117

DO - 10.2215/CJN.13041117

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C2 - 29848505

AN - SCOPUS:85049781129

VL - 13

SP - 1037

EP - 1046

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

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