Cast Nephropathy With Light-Chain Disease In Low Grade Lymphoplasmacytic Lymphoma/Waldenstrm Macroglobulinemia

The Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPC) is a rare low-grade B cell, non Hodgkin lymphoma characterized by the involvement of the bone marrow and various organs, especially hepatosplenomegaly, by lymphoplasmacytic tumoral B cells, responsible for IgM monoclonal gammopathy secreted in the serum. Renal involvement in WM has been previously described. Various forms of glomerular injuries were reported: large intracapillary IgM aggregates (so called "thrombi"), cryoglobulinemia-associated type 1 membranoproliferative glomerulonephritis, or AL amyloidosis. Interstitial infiltration by tumoral B-lymphocytes is also a classical pattern. Conversely, tubular involvement in the form of myeloma-like casts associated with basement membranes deposits of monoclonal light chain (light-chain deposition disease, LCDD) is exceptional during WM. To the best of our knowledge, the association of the two conditions in the same patient has not been reported so far. Here, we report cast nephropathy with LCDD in three WM-patients, which resulted in severe renal failure.