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Nephrology 20 (2015) 306–308
Correspondence ANURIC RENAL FAILURE IN A PATIENT WITH WALDENSTROM’S MACROGLOBULINAEMIA Jonathan Ling,1 David Challis,2 William Johnson3 and Steven Yew1, 1Nephrology Unit, 2Anatomical Pathology and 3General Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia A 73-year-old man with known Waldenstrom’s macroglobulinaemia (WM) had anuric acute kidney injury (AKI) following an elective cholecystectomy. On admission, he was euvolaemic with a creatinine of 878 micromol/L, significant haematuria (>9000 × 106/L erythrocytes) and proteinuria (urine albumin : creatinine ratio 490 g/mol creatinine). He had undetected haematuria and a rising creatinine from 79 micromol/L 4 months ago to 138 micromol/L preoperatively. He was haemodialysed and treated for presumed crescentic glomerulonephritis with plasmapheresis and pulsed intravenous methylprednisolone. Other investigations showed hypocomplementaemia (C3 0.31 g/L, C4 0.03 g/L), normal cryoglobulins and a high immunoglobulin M (IgM) level of 4.57 g/L. Renal biopsy revealed abnormal glomeruli with extensive subendothelial deposits staining positive for IgM, C3 with no specific substructure to suggest cryoglobulinaemia. Lambda light chains (LLC) with intra-capillary thrombi, mild mesangial expansion and hypercellularity with concurrent acute tubular necrosis (ATN) were seen (Fig 1). Serum LLC were elevated at 7778 mg/L with a kappa/lambda ratio of
Nephrology 20 (2015) 306–308
Correspondence ANURIC RENAL FAILURE IN A PATIENT WITH WALDENSTROM’S MACROGLOBULINAEMIA Jonathan Ling,1 David Challis,2 William Johnson3 and Steven Yew1, 1Nephrology Unit, 2Anatomical Pathology and 3General Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia A 73-year-old man with known Waldenstrom’s macroglobulinaemia (WM) had anuric acute kidney injury (AKI) following an elective cholecystectomy. On admission, he was euvolaemic with a creatinine of 878 micromol/L, significant haematuria (>9000 × 106/L erythrocytes) and proteinuria (urine albumin : creatinine ratio 490 g/mol creatinine). He had undetected haematuria and a rising creatinine from 79 micromol/L 4 months ago to 138 micromol/L preoperatively. He was haemodialysed and treated for presumed crescentic glomerulonephritis with plasmapheresis and pulsed intravenous methylprednisolone. Other investigations showed hypocomplementaemia (C3 0.31 g/L, C4 0.03 g/L), normal cryoglobulins and a high immunoglobulin M (IgM) level of 4.57 g/L. Renal biopsy revealed abnormal glomeruli with extensive subendothelial deposits staining positive for IgM, C3 with no specific substructure to suggest cryoglobulinaemia. Lambda light chains (LLC) with intra-capillary thrombi, mild mesangial expansion and hypercellularity with concurrent acute tubular necrosis (ATN) were seen (Fig 1). Serum LLC were elevated at 7778 mg/L with a kappa/lambda ratio of
