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May 24, 2017

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 membranous glomerulopathy (see references below).

References:

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 membranous glomerulopathy.

Audard V, Georges B, et al. Renal lesions associated with IgM-secreting monoclonal proliferations: revisiting the disease spectrum. Clin J Am Soc Nephrol. 2008 Sep; 3(5):1339-49. PubMed PMID: 18632851.

Chauvet S, Bridoux F, et al. Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients. Am J Kidney Dis. 2015 Nov;66(5):756-67. PubMed PMID: 25987261.