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Naka R, Shimomura Y, Kanda-Kato M, Hiramoto N, Hara S, Ishikawa T. Direct infiltration of clonal plasma cells causes renal insufficiency in patients with monoclonal gammopathy of undetermined significance. EJHAEM 2023; 4:829-832. [PMID: 37601873 PMCID: PMC10435693 DOI: 10.1002/jha2.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 08/22/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a benign but precancerous condition that can progress to multiple myeloma. Patients with MGUS are typically monitored closely for signs of disease progression, but in some cases, they may also develop renal insufficiency, a condition known as monoclonal gammopathy of renal significance (MGRS). In MGRS, M-protein secreted by a nonmalignant or premalignant cell clone triggers renal damage by definition. Herein, we report a case of a 66-year-old Asian male with MGUS complicated by renal insufficiency. A kidney biopsy showed no evidence of renal injury mediated by M-protein; instead, the direct infiltration of clonal cells into renal tissues was observed. Although five similar cases have been previously reported, our case is unique in that the involvement of clonal cells was directly confirmed by fluorescence in situ hybridization. Our findings suggest the need to consider a novel disease concept, as this phenomenon appears to be reproduced.
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Affiliation(s)
- Ryosuke Naka
- Department of Hematology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
| | - Yoshimitsu Shimomura
- Department of Hematology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
- Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Osaka Japan
| | - Madoka Kanda-Kato
- Department of Hematology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
| | - Nobuhiro Hiramoto
- Department of Hematology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
| | - Takayuki Ishikawa
- Department of Hematology Kobe City Hospital Organization Kobe City Medical Center General Hospital Kobe Japan
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Tubulointerstitial nephritis with IgA kappa-positive plasma cells in a patient with primary Sjögren’s syndrome and monoclonal gammopathy. CEN Case Rep 2022; 12:200-204. [PMID: 36367665 PMCID: PMC10151436 DOI: 10.1007/s13730-022-00752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022] Open
Abstract
This is a case report of a 69-year-old Japanese man who has been undergoing treatment for primary Sjögren's syndrome (pSS) since he was 62 years. A renal biopsy, which revealed diffuse and severe mononuclear cell infiltration in the tubulointerstitium, was performed because of progressive renal dysfunction. Immunostaining demonstrated most of the infiltrating cells to be IgA, kappa, CD38, and CD138 positive. Immunofixation blood test revealed IgA kappa-type M protein; however, bone marrow abnormalities or lymph node enlargements on examination or imaging, respectively, were not observed. Tubulointerstitial nephritis caused by monotypic plasmacytic infiltration in pSS, accompanied with a monoclonal gammopathy of undetermined significance (MGUS), was diagnosed. A treatment of prednisolone 40 mg/day was initiated, promptly improving the patient's serum creatinine levels from 3.0 to 1.5 mg/dl. The infiltrating cells in pSS-associated tubulointerstitial nephritis are generally polytypic plasmacytes and lymphocytes, but in the present case, monotypic plasmacytes were predominant. This case is remarkable and rare and can be considered a complication of pSS or MGUS. Since it may become a new disease entity, it is important to accumulate similar cases.
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Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits. Diagnostics (Basel) 2021; 11:diagnostics11040710. [PMID: 33921123 PMCID: PMC8071536 DOI: 10.3390/diagnostics11040710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.
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Hou G, Jin M, Ye Z, Zhang X, Huang Q, Ye M. Ameliorate effects of soybean soluble polysaccharide on adenine-induced chronic renal failure in mice. Int J Biol Macromol 2020; 149:158-164. [PMID: 31931056 DOI: 10.1016/j.ijbiomac.2020.01.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/03/2023]
Abstract
In the present study, the kidney protection effects of soluble soybean polysaccharide (SSPS) were evaluated. To address the issues, a mice model of Chronic renal failure (CRF) was established by gavage 0.2% (w/w) adenine for 3 weeks. In vivo results showed that SSPS could change the concentrations of blood urea nitrogen (BUN), creatinine (CRE), total protein (TP) and albumin (ALB), thereby affecting kidney function. In addition, Masson histopathology analysis indicated that SSPS could decrease the area of collagen fiber in the kidney tissues of CRF mice. Moreover, the results of mRNA expression and western experiment suggested that SSPS treatment could increase the expression of transforming growth factor-β (TGF-β), Smad3 and P-Smad3, while reduce the expression of α smooth muscle actin (α-SMA) when compared with the model group. These results indicated that SSPS potentially improve kidney function through TGF/Smad pathway in CRF mice.
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Affiliation(s)
- Guohua Hou
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Mingzhi Jin
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Ziyang Ye
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Xinmiao Zhang
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Qianli Huang
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China; School of Resources and Environmental Engineering, Hefei University of Technology, Hefei 230009, China.
| | - Ming Ye
- Microbial Resources and Application Laboratory, School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China.
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Saeki T, Kuroha T, Sato Y, Tamura M, Iguchi A, Ito T, Yamazaki H, Ito Y, Yoshita K, Imai N, Narita I, Usuda H. Tubulointerstitial nephritis with monotypic lympho-plasmacytic infiltrates in a patient with primary Sjögren's syndrome accompanied by IgA-type monoclonal gammopathy. BMC Nephrol 2019; 20:464. [PMID: 31842799 PMCID: PMC6915943 DOI: 10.1186/s12882-019-1646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Although most cases of tubulointerstitial nephritis in paraproteinemia are monoclonal light chain deposition-mediated, interstitial nephritis as neoplastic interstitial cell infiltration has rarely been described. On the other hand, lympho-plasma-cell-rich tubulointerstitial nephritis, in which the infiltrative cells are usually polytypic, is often evident in primary Sjögren’s syndrome (pSS). Herein we present a rare case of pSS in a patient who had been diagnosed as having IgA kappa-type monoclonal gammopathy of undetermined significance (MGUS) and developed tubulointerstitial nephritis with monotypic (IgA kappa) lympho-plasmacytic infiltrates. Case presentation A 74-year-old Japanese woman with pSS who had been diagnosed as having IgA kappa-type MGUS developed progressive renal dysfunction. Renal biopsy revealed tubulointerstitial nephritis with abundant plasma cell-rich mononuclear cell infiltrates without atypia. Immunohistochemical staining for immunoglobulins and light chains showed that most infiltrates were positive for IgA and kappa. Most of the infiltrative cells were positive for CD38 and CD138, and cells positive for CD 19 and CD 45 were also widely evident. Electron microscopy and immunofluorescence studies revealed no apparent immunological deposits in the glomeruli and tubules. Bone marrow and whole-body radiological examinations revealed no findings suggestive of multiple myeloma or lymphoma. Renal function improved rapidly with prednisolone 40 mg daily and has been maintained at the same level on low-dose prednisolone and azathioprine for 18 months. Conclusion Tubulointerstitial nephritis with monotypic cell infiltrates, without immunological deposits, is a quite rare histological picture in MGUS, and might be a unique renal manifestation in patients with pSS.
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Affiliation(s)
- Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan.
| | - Takashi Kuroha
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Yuya Sato
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Maasa Tamura
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Akira Iguchi
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Tomoyuki Ito
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Hajime Yamazaki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Yumi Ito
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Kazuhiro Yoshita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Naofumi Imai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Hiroyuki Usuda
- Department of Pathology, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
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Saglam A, Balaban S, Yıldırım T, Erdem Y, Uner A, Büyükaşık Y. Monoclonal gammopathy of renal significance presenting as monotypic plasma cell interstitial nephritis in two patients with Sjögren's syndrome. Virchows Arch 2017; 472:865-869. [PMID: 29147924 DOI: 10.1007/s00428-017-2270-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Arzu Saglam
- Department of Pathology, Hacettepe University School of Medicine, Sıhhıye, 06100, Ankara, Turkey.
| | - Seda Balaban
- Department of Internal Medicine, Division of Hematology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Division of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yunus Erdem
- Department of Internal Medicine, Division of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysegul Uner
- Department of Pathology, Hacettepe University School of Medicine, Sıhhıye, 06100, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Internal Medicine, Division of Hematology, Hacettepe University School of Medicine, Ankara, Turkey
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