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Renal Lesions Associated with IgM-Secreting Monoclonal Proliferations: Revisiting the Disease Spectrum

Vincent Audard^*, Benoit Georges, Philippe Vanhille, Cécile Toly^,||, Benjamin Deroure^¶, Fadi Fakhouri^**, René Cuvelier, Xavier Belenfant, Brigitte Surin, Pierre Aucouturier^||, Béatrice Mougenot^||||, and Pierre Ronco^,¶¶

^* Nephrology and Renal Transplantation Department, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris (APHP), Institut Francilien de recherche en Néphrologie et Transplantation, INSERM U 841, University of Paris 12, Créteil, France; Nephrology Department, Centre hospitalier de Namur, Namur, Belgium; Nephrology Department, Hôpital de Valenciennes, Valenciennes, France; Hematology and Immunology Department, Hôpital Tenon, APHP, Université Pierre et Marie Curie (UPMC) University of Paris 06, Paris, France; ^|| Hôpital Saint Antoine, INSERM, UMR S 712, APHP, UPMC University of Paris 06, Paris, France; ^¶ Nephrology and Renal Transplantation Department, Hôpital Kremlin Bicêtre, APHP, Le Kremlin Bicêtre, France; ^** Nephrology Department, Hôpital Necker, APHP, University of Paris 05, Paris, France; Nephrology Department, Centre hospitalier de Mouscron, Mouscron, Belgium; Nephrology Department, Hôpital de Montreuil, Montreuil, France; INSERM UMR S 702; UPMC University of Paris 06, Paris, France; and ^|||| Pathology Department and ^¶¶ Nephrology Department, Hôpital Tenon, APHP, Paris, France

Correspondence: Dr. Vincent Audard, Henri Mondor Hospital, Nephrology Department, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France; Phone: 33-1-49-81-24-53; Fax: 33-1-49-81-24-52; E-mail: vincent.audard{at}hmn.aphp.fr; or Dr. Pierre Ronco, Tenon Hospital, Nephrology Department, 4 rue de la Chine, 75020 Paris; Phone: 33-1-56-01-66-39; Fax: 33-1-56-01-69-99; E-mail: pierre.ronco{at}tnn.aphp.fr

Background and objectives: Since the first description of pathology of the kidney in Waldenström disease in 1970, there have been few reports on kidney complications of IgM-secreting monoclonal proliferations. Here, we aimed to revisit the spectrum of renal lesions occurring in patients with a serum monoclonal IgM.

Design, setting, participants, & measurements: Fourteen patients with a circulating monoclonal IgM and a kidney disease related to B cell proliferation were identified retrospectively. Demographic, clinical, and laboratory data were assessed for each patient at the time of kidney biopsy.

Results: Seven patients had a nephrotic syndrome. Patients without nephrotic syndrome all had impaired renal function. Mean serum creatinine was 238 µmol/L. For five patients, the diagnosis of monoclonal IgM preceded the kidney disease by 28.8 mo (range 12 to 60). Seven patients had Waldenström disease, two had a small B cell non-Hodgkin lymphoma, one had an IgM-excreting multiple myeloma, one had a marginal zone B cell lymphoma, and three had an IgM-related disorder. Renal lesions included (1) intracapillary monoclonal deposits disease with granular, electron-dense IgM thrombi occluding capillary lumens (5); (2) atypical membranoproliferative glomerulonephritis (3); (3) light chain amyloidosis (2) associated with µ deposits in one patient; (4) acute tubular necrosis (1); and (5) CD20⁺ lymphomatous infiltration (3). Remission of the nephrotic syndrome was attained in three of seven patients, and renal function improved after chemotherapy.

Conclusions: Although renal complications of IgM proliferations are rare, a wide spectrum of kidney lesions is observed, without correlation with the type of hematologic disorder.