Skip to main content
SpringerLink
Log in

Concurrent isolated IgG2-positive membranous nephropathy and malignant B-cell lymphoma

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

A recent systematic review showed that hematological malignancy is often complicated by membranous nephropathy (MN). Histologically, the deposition of IgG subclasses other than IgG4 may imply secondary MN, such as malignancy-associated MN (M-MN). We describe a very rare case of concurrent isolated IgG2-positive MN and B-cell lymphoma. An 83-year-old woman was hospitalized at our institute for facial and lower extremity edema persisting for 2 months. Laboratory tests showed urinary protein level of 10.8 g/day, serum albumin level of 1.6 g/dl, and serum creatinine level of 2.34 mg/dl. Soon after diagnosis of nephrotic syndrome, treatment with corticosteroid was initiated, but it proved to be ineffective. Renal biopsy showed isolated IgG2-positive MN with highly infiltrated CD20-positive lymphoid cells in the kidney. Computed tomography revealed systemic lymphadenopathy, and aberrant B-cells with immunoglobulin light chain restriction were detected in peripheral blood and bone marrow, which led to the diagnosis of mature B-cell lymphoma. Although rituximab (375 mg/m2/week) was administered, the patient suddenly died from gastrointestinal bleeding on day 40 of hospitalization. It is, thus, necessary to consider hematological malignancy when a diagnosis of MN is made. Further studies are expected to elucidate the pathogenesis and to help establish the adequate treatment for this rare situation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Richmond J, Sherman RS, Diamond HD, Craver LF. Renal lesions associated with malignant lymphomas. Am J Med. 1962;32(2):184–207.

    Article  CAS  PubMed  Google Scholar 

  2. Lien Y-HH, Lai L-W. Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis. Nat Rev Nephrol. 2011;7(2):85–95.

    Article  CAS  PubMed  Google Scholar 

  3. Leeaphorn N, Kue-A-Pai P, Thamcharoen N, Ungprasert P, Stokes MB, Knight EL. Prevalence of cancer in membranous nephropathy: a systematic review and meta-analysis of observational studies. Am J Nephrol. 2014;40(1):29–35.

    Article  PubMed  Google Scholar 

  4. Doi T, Mayumi M, Kanatsu K, Suehiro F, Hamashima Y. Distribution of IgG subclasses in membranous nephropathy. Clin Exp Immunol. 1984;58(1):57–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ, Sloand JA, Rosenblatt J, Sanz I. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose-escalation trial of rituximab. Arthritis Rheum. 2004;50(8):2580–9.

    Article  CAS  PubMed  Google Scholar 

  6. Stasi R, Stipa E, Del Poeta G, Amadori S, Newland A, Provan D. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab. Rheumatology. 2006;45(11):1432–6.

    Article  CAS  PubMed  Google Scholar 

  7. Gilbert RD, Hulse E, Rigden S. Rituximab therapy for steroid-dependent minimal change nephrotic syndrome. Pediatr Nephrol. 2006;21(11):1698–700.

    Article  PubMed  Google Scholar 

  8. Remuzzi G, Chiurchiu C, Abbate M, Brusegan V, Bontempelli M, Ruggenenti P. Rituximab for idiopathic membranous nephropathy. Lancet. 2002;360(9337):923–4.

    Article  CAS  PubMed  Google Scholar 

  9. Fornoni A, Sageshima J, Wei C, Merscher-Gomez S, Aguillon-Prada R, Jauregui AN, Li J, Mattiazzi A, Ciancio G, Chen L, Zilleruelo G, Abitbol C, Chandar J, Seeherunvong W, Ricordi C, Ikehata M, Rastaldi MP, Reiser J, Burke 3rd GW. Rituximab targets podocytes in recurrent focal segmental glomerulosclerosis. Sci Transl Med. 2011;3(85):85ra46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Togashi M, Wakui H, Kodama K, Kameoka Y, Komatsuda A, Nimura T, Ichinohasama R, Sawada K. Angioimmunoblastic T-cell lymphoma and membranous nephropathy: a still unreported association. Clin Exp Nephrol. 2010;14(3):288–93.

    Article  PubMed  Google Scholar 

  11. Da’as N, Polliack A, Cohen Y, Amir G, Darmon D, Kleinman Y, Goldfarb AW, Ben-Yehuda D. Kidney involvement and renal manifestations in non-Hodgkin’s lymphoma and lymphocytic leukemia: a retrospective study in 700 patients. Eur J Haematol. 2001;67(3):158–64.

    Article  PubMed  Google Scholar 

  12. Qu Z, Liu G, Li J, Wu L-h, Tan Y, Zheng X, Ao J, Zhao MH. Absence of glomerular IgG4 deposition in patients with membranous nephropathy may indicate malignancy. Nephrol Dial Transplant. 2012;27(5):1931–7.

    Article  CAS  PubMed  Google Scholar 

  13. Ohtani H, Wakui H, Komatsuda A, Okuyama S, Masai R, Maki N, Kigawa A, Sawada K, Imai H. Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. Nephrol Dial Transplant. 2004;19(3):574–9.

    Article  CAS  PubMed  Google Scholar 

  14. Guiard E, Karras A, Plaisier E, Van Huyen J-PD, Fakhouri F, Rougier J-P, Noel LH, Callard P, Delahousse M, Ronco P. Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab. Clin J Am Soc Nephrol. 2011;6(7):1609–16.

    Article  CAS  PubMed  Google Scholar 

  15. Ohashi R, Sakai Y, Otsuka T, Ohno D, Masuda Y, Murasawa T, Sato N, Shimizu A. Proliferative glomerulonephritis with monoclonal IgG2κ deposit successfully treated with steroids: a case report and review of the literature. CEN case reports. 2013;2(2):197–203.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fervenza FC, Abraham RS, Erickson SB, Irazabal MV, Eirin A, Specks U, Nachman PH, Bergstralh EJ, Leung N, Cosio FG, Hogan MC, Dillon JJ, Hickson LJ, Li X, Cattran DC. Mayo Nephrology Collaborative Group. Rituximab therapy in idiopathic membranous nephropathy: a 2-year study. Clin J Am Soc Nephrol. 2010;5(12):2188–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Domizio P, Owen R, Shepherd N, Talbot I, Norton A. Primary Lymphoma of the Small Intestine A. Clinicopathological Study of 119 Cases. Am J Surg Pathol. 1993;17(5):429–42.

    Article  CAS  PubMed  Google Scholar 

  18. Howlett D, Farrugia M, Irvine A. Therapeutic transcatheter embolotherapy in the control of recurrent haemorrhage from lymphoma of the small bowel. Br J Radiol. 1995;68(808):431–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We appreciate Ryoko Saito for valuable advice on pathological findings and Kiyomi Kisu for her technical assistance.

Author information

Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Satoshi Shimada, Takashi Nakamichi, Gen Yamada, Kaori Narumi, Tae Yamamoto, Mariko Miyazaki, Hiroshi Sato & Sadayoshi Ito

  2. Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Satoshi Ichikawa, Noriko Fukuhara & Hideo Harigae

  3. Department of Pathology, Tohoku University Hospital, Sendai, Japan

    Hajime Usubuchi

Authors
  1. Satoshi Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Nakamichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gen Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaori Narumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hajime Usubuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tae Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Satoshi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noriko Fukuhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mariko Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hideo Harigae
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroshi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sadayoshi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takashi Nakamichi.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shimada, S., Nakamichi, T., Yamada, G. et al. Concurrent isolated IgG2-positive membranous nephropathy and malignant B-cell lymphoma. CEN Case Rep 7, 248–252 (2018). https://doi.org/10.1007/s13730-018-0336-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-018-0336-z

Keywords

Search

Navigation