Mixed cryoglobulinemic membranoproliferative glomerulonephritis due to monoclonal gammopathy of undetermined significance

Abstract

Rationale:Membranoproliferative glomerulonephritis (MPGN) can be induced by autoimmune diseases, chronic infection, chronic hepatitis, and paraproteins (including cryoglobulinemia). In addition, the mixed cryoglobulinemic MPGN is reported to be highly correlated with hepatitis C virus (HCV) infection.Patient concerns:We reported a rare case of a 61-year-old woman without a history of viral hepatitis infection; she presented with bilateral leg edema and proteinuria. Renal pathology revealed MPGN with multiple positive immunofluorescent staining. The consequent serum survey revealed positive cryoglobulin and monoclonal gammopathy of kappa type of immunoglobulin M. However, bone marrow study showed no obvious plasma cell proliferation, indicating that multiple myeloma was less likely.Diagnoses:This patient's cryoglobulinemic MPGN could be related to monoclonal gammopathy of undetermined significance.Interventions:Oral immunosuppressant.Outcomes:After steroid treatment, her renal function normalized and proteinuria kept in low level.Lessons:We demonstrated a rare cause of cryoglobulinemic MPGN without HCV infection, which led to a favorable prognosis after receiving steroid therapy. Moreover, the diagnosis of monoclonal gammopathy should be considered when facing such case and aggressive steroid therapy might be beneficial.

Cryoglobulinemic Vasculitis Associated with Monoclonal Gammopathy of Undetermined Significance Developed after Sustained Virologic Response of Hepatitis C

“…The most common causes of cryoglobulinemia due to hematological diseases are B-cell lymphoma and multiple myeloma; however, MGUS also causes cryoglobulinemia (23,24). Although cryoglobulinemia due to LPDs tends to develop into type I cryoglobulinemia, MGUS can also cause MC (6,25). HCV infection increases the risk of developing B-cell lymphoma and MGUS because chronic antigen stimulation of lymphocytes is postulated to be the cause (26).…”

Detectable serum IgM monoclonal gammopathy in non-hepatitis-associated mixed cryoglobulinemic glomerulonephritis: A case report and literature review

“…Table 2 summarizes a review of the literature of the noninfectious mixed (type II) cryoglobulinemic glomerulonephritis, in which the association with serum monoclonal gammopathy was determined. 9,[13][14][15][16][17][18] Interestingly, all of the cases of the noninfectious mixed cryoglobulinemia with positive serum monoclonal gammopathy were linked with serum IgM kappa monoclonal antibody. We speculated that the IgM monoclonal gammopathy might have high autoantibody activity that allows for the formation of an immune complex, as also observed in Waldenström macroglobulinemia.…”