Renal transplantation in Waldenström's macroglobulinaemia

A 60-year-old man presented with hypertension, proteinuria and renal failure. He had an IgM lambda plasma and urinary paraprotein, but bone-marrow examination and skeletal survey were normal, and renal biopsy was felt to be consistent with chronic pyelonephritis. Renal failure progressed, and haemodialysis and later cadaveric renal transplantation were performed. He died 7 months after transplantation from pulmonary thromboembolism. Postmortem examination and review with immunohistochemical techniques of his original renal biopsy revealed his renal disease to have been macroglobulinaemic nephropathy which had recurred in his renal allograft.