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Nephrotic syndrome caused by protein thrombi in glomerulocapillary lumen in Waldenström's macroglobulinaemia

Y Harada1, N Ido, T Okada

  • 1The Third Department of Internal Medicine, Tokyo Medical University Hospital, Tokyo, Japan. yharada@tokyo-med.ac.jp

British Journal of Haematology
|October 29, 2000
PubMed

Insights

Waldenström's macroglobulinaemia can cause kidney problems like nephrotic syndrome due to immunoglobulin M paraprotein thrombi. Treatment with corticosteroids and plasmapheresis showed promise in reversing these kidney complications.

Area of Science:

  • Nephrology
  • Hematology
  • Oncology

Background:

  • Waldenström's macroglobulinaemia (WM) is a rare lymphoproliferative disorder affecting plasmacytoid lymphocytes.
  • Renal complications in WM are infrequent but can be severe, unlike those in multiple myeloma.
  • Nephrotic syndrome is an uncommon but significant renal manifestation of WM.

Observation:

  • A case study presented a patient with Waldenström's macroglobulinaemia experiencing nephrotic syndrome.
  • Kidney biopsy revealed intraglomerular thrombi composed of immunoglobulin M (IgM) paraprotein.
  • These IgM paraprotein thrombi were identified as the cause of nephrotic syndrome.

Findings:

  • Corticosteroid pulse therapy and plasmapheresis were administered to the patient.
  • These therapeutic interventions led to significant improvement in proteinuria.
  • A reduction in the size and presence of protein thrombi was observed post-treatment.

Implications:

  • The findings suggest that nephrotic syndrome secondary to protein thrombi in WM may be reversible.
  • Early diagnosis and intervention are crucial for managing renal complications in WM.
  • This case highlights the potential efficacy of combined corticosteroid and plasmapheresis therapy in WM-related nephropathy.

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