Monoclonal gammopathy of renal significance presenting with cryoglobulinaemia type I associated severe thrombotic microangiopathy

ABSTRACT We report a 53-year-old man who presented with acute renal failure. His medical history revealed a spondyloarthropathy, for which secukinumab was started recently, and a monoclonal gammopathy of unknown significance. Kidney function deteriorated despite the withdrawal of secukinumab and dialysis was started. In the serum, type 1 cryoglobulins were present and a kidney biopsy showed ischaemic glomeruli, with thrombosis of the larger interlobular arteries. Other causes of thrombotic microangiopathy were excluded. Bone marrow immunophenotyping showed 1% monoclonal plasma cells. A diagnosis of monoclonal gammopathy of renal significance was made. Haematological treatment resulted in haematological and renal response.

[1]  V. D’Agati,et al.  The Complexity and Heterogeneity of Monoclonal Immunoglobulin-Associated Renal Diseases. , 2018, Journal of the American Society of Nephrology : JASN.

[2]  F. Fervenza,et al.  Thrombotic microangiopathy associated with monoclonal gammopathy. , 2017, Kidney international.

[3]  AACR Project GENIE: Powering Precision Medicine through an International Consortium. , 2017, Cancer discovery.

[4]  D. Lipsker,et al.  Clinico‐biological characteristics and treatment of type I monoclonal cryoglobulinaemia: a study of 64 cases , 2015, British journal of haematology.

[5]  S. Maruyama,et al.  A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy , 2015, CEN Case Reports.

[6]  B. Grosbois,et al.  Long‐term outcome of monoclonal (type 1) cryoglobulinemia , 2014, American journal of hematology.

[7]  Hiroshi Sato,et al.  [Membranoproliferative glomerulonephritis]. , 2004, Nihon rinsho. Japanese journal of clinical medicine.

[8]  John P. Johnson,et al.  The Clinical and Morphologic Spectrum of Renal Cryoglobulinemia , 2002, Medicine.

[9]  S. Meri,et al.  Nephritogenic lambda light chain dimer: a unique human miniautoantibody against complement factor H. , 1999, Journal of immunology.

[10]  A. Magil,et al.  Thrombotic microangiopathy associated with cryoglobulinemic membranoproliferative glomerulonephritis and hepatitis C. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  S. Meri,et al.  Activation of the alternative pathway of complement by monoclonal lambda light chains in membranoproliferative glomerulonephritis , 1992, The Journal of experimental medicine.