• Seongmin Kim, Wooram Bae, Jungyoon Choi, Tae Won Lee, Dae Hyun Song, Eunjin Bae, Ha Nee Jang, Se-Ho Chang, and Dong Jun Park.
• Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
• Medicine (Baltimore). 2022 Jun 17; 101 (24): e29449.

IntroductionWaldenström's macroglobulinemia is a lymphoplasmacytic lymphoma (LPL) associated with a monoclonal immunoglobulin M protein. Although acute kidney injury (AKI) due to immunoglobulin M paraprotein infiltration into the renal interstitium has been reported, there has been no report of AKI with invasion of the immunoglobulin G paraprotein into the renal interstitium in a patient with LPL.Patient ConcernsA 65-year-old male was admitted to our hospital with fatigue and decreased renal function. He complained of a 3-kg weight loss in the last 3 months.DiagnosisThe initial blood urea nitrogen and serum creatinine levels were 55.9 and 1.83 mg/dL, respectively. Serum protein electrophoresis revealed a monoclonal component (3.5 g/dL) in the gamma region and immunofixation electrophoresis showed an immunoglobulin G kappa monoclonal protein. Renal pathology revealed that CD3-CD20+ CD138+ lymphoid cells had infiltrated the renal interstitium. A bone marrow biopsy was compatible with LPL.InterventionsIntravenous methylprednisolone (1 mg/kg) was administered after confirming the renal pathological findings.OutcomesSerum creatinine decreased to 0.8 mg/dL 14 days after treatment.ConclusionsPhysicians should recognize LPL secreting various immunoglobulins as a possible cause of AKI when renal failure of unknown etiology and serum immunoglobulin paraprotein is present. A kidney biopsy should be performed for definitive diagnosis and appropriate management.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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