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Waldenström’s Macroglobulinemia

Waldenström's Macroglobulinemia, arkana laboratories, teaching points for renal pathology, kidney biopsy
A 57-year-old white male presents with fatigue, mild proteinuria, and a creatinine of 1.5 mg/dL. He was diagnosed with lymphoplasmacytic lymphoma 6 months ago, but refused treatment. Figures 1 & 2 show prominent pseudothrombi and a membranoproliferative pattern of glomerular injury. Image 3 shows moderate interstitial fibrosis. Image 4, 5, 6, & 7 show IgG, IgM, kappa, and lambda, respectively. This is a case of cryoglobulinemic glomerulonephritis secondary to lymphoplasmacytic lymphoma (Waldenström's macroglobulinemia). Waldenström's macroglobulinemia is a rare B-cell lymphoma characterized by lymphoplasmacytic cell infiltration in the bone marrow and other organs and the presence of a monoclonal immunoglobulin M...

Waldenstrom Macroglobulinemia

In this image of a combined silver-trichrome stain, the arrow points to the abnormal material within the arteriole lumen. This material was positive for IgM and showed kappa light chain restriction by immunofluorescence, supporting the diagnosis of paraprotein. Interestingly, this kidney biopsy was taken from an 81-year-old man with acute renal failure who had been diagnosed with Waldenström macroglobulinemia (his bone marrow biopsy showed involvement by lymphoplasmacytic lymphoma and he had a circulating IgM-kappa paraprotein). A key point to remember is that monoclonal IgM paraproteins are associated with a wide spectrum of kidney diseases, including AL-type amyloidosis, cryoglobulinemic glomerulonephritis, and...