Premium
Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes
Author(s) -
Vos Josephine M.,
Gustine Joshua,
Rennke Helmut G.,
Hunter Zachary,
Manning Robert J.,
Dubeau Toni E.,
Meid Kirsten,
Minnema Monique C.,
Kersten MarieJose,
Treon Steven P.,
Castillo Jorge J.
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14279
Subject(s) - medicine , lymphoplasmacytic lymphoma , nephropathy , thrombotic microangiopathy , membranous nephropathy , renal biopsy , amyloidosis , waldenstrom macroglobulinemia , gastroenterology , kidney disease , al amyloidosis , renal function , nephrotic syndrome , renal pathology , pathology , cohort , kidney , glomerulonephritis , disease , immunology , lymphoma , immunoglobulin light chain , endocrinology , diabetes mellitus , antibody
Summary The incidence and prognostic impact of nephropathy related to Waldenström macroglobulinaemia ( WM ) is currently unknown. We performed a retrospective study to assess biopsy‐confirmed WM ‐related nephropathy in a cohort of 1391 WM patients seen at a single academic institution. A total of 44 cases were identified, the estimated cumulative incidence was 5·1% at 15 years. There was a wide variation in kidney pathology, some directly related to the WM : amyloidosis ( n = 11, 25%), monoclonal‐IgM deposition disease/cryoglobulinaemia ( n = 10, 23%), lymphoplasmacytic lymphoma infiltration ( n = 8, 18%), light‐chain deposition disease ( n = 4, 9%) and light‐chain cast nephropathy ( n = 4, 9%), and some probably related to the WM : thrombotic microangiopathy ( TMA ) ( n = 3, 7%), minimal change disease ( n = 2, 5%), membranous nephropathy ( n = 1, 2%) and crystal‐storing tubulopathy ( n = 1, 2%). The median overall survival in patients with biopsy‐confirmed WM ‐related nephropathy was 11·5 years, shorter than for the rest of the cohort (16 years, P = 0·03). Survival was better in patients with stable or improved renal function after treatment ( P = 0·05). Based on these findings, monitoring for renal disease in WM patients should be considered and a kidney biopsy pursued in those presenting with otherwise unexplained renal failure and/or nephrotic syndrome.