Infection as a trigger of acute, transient glomerular deposition of clonal immunoglobulins

ABSTRACT

Glomerular deposition of monoclonal IgM, frequently in the form of intracapillary pseudothrombi, can be seen in Waldenström macroglobulinemia (WM) and type I cryoglobulinemia (CG). They are typically associated with plasma cell or B-lymphoid neoplasms, particularly lymphoplasmacytic lymphoma (LPL). While infection is a frequent trigger of mixed (type II and III) CG, its association with type I CG is uncommon. We report two cases in which striking lambda-chain-restricted IgM deposits and acute kidney injury (AKI) occurred in the setting of known or suspected systemic infections, with prompt resolution on treatment of the infection.

KEYWORDS:

• Cryoglobulinemia
• glomerulonephritis
• renal biopsy
• Waldenström macroglobulinemia

Acknowledgments

The expert technical assistance of Ms. Maureen Petersen is gratefully acknowledged. We are also indebted to the patients whose experiences have helped us learn.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions statement

BW, MS, and DH contributed to the design and conception of the work. BW and DH performed the acquisition, analysis, and interpretation of data and drafted the work. MS and DR critically reviewed and edited it for important intellectual content. All authors had final approval of the version to be published.

Data availability statement

There is no data set associated with this work.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.