Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes

Br J Haematol. 2016 Nov;175(4):623-630. doi: 10.1111/bjh.14279. Epub 2016 Jul 29.

Abstract

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.

Keywords: Waldenström macroglobulinaemia; amyloidosis; epidemiology; haemodialysis; renal medicine.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Biopsy
  • Female
  • Humans
  • Incidence
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / etiology*
  • Kidney Diseases / therapy
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Waldenstrom Macroglobulinemia / complications*
  • Waldenstrom Macroglobulinemia / epidemiology*
  • Waldenstrom Macroglobulinemia / therapy

Substances

  • Biomarkers