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Monoclonal Gammopathy of Renal Significance in a Patient With Cryoglobulinemia and Nephrotic Syndrome: A Case Report
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Monoclonal Gammopathy of Renal Significance in a Patient With Cryoglobulinemia and Nephrotic Syndrome: A Case Report
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Journal Article
Monoclonal Gammopathy of Renal Significance in a Patient With Cryoglobulinemia and Nephrotic Syndrome: A Case Report
2025
Overview
We report a case of monoclonal gammopathy of renal significance (MGRS) in a 65-year-old female patient who presented to the emergency department with uncontrolled hypertension, generalized edema, abdominal distension, and frothy urine. Apart from recently diagnosed hypertension, she had no significant comorbidities. Examination revealed periorbital swelling, bibasal crackles, moderate ascites, and bilateral lower limb pitting edema. Laboratory findings showed proteinuria, low complement levels, elevated IgM, decreased IgG, and the presence of cryoglobulins. Imaging and PET-CT ruled out malignancy. Kidney biopsy revealed membranoproliferative glomerulonephritis with cryoglobulin deposition and vasculitis. Bone marrow biopsy confirmed plasma cell dyscrasia with kappa light chain restriction. Despite suspicion of Waldenström macroglobulinemia or IgM myeloma, cytogenetics and fluorescence in situ hybridization were negative. The patient was treated with rituximab and corticosteroids, with complete resolution of ascites, edema, and proteinuria. This case highlights an uncommon presentation of IgM kappa-related MGRS with type I cryoglobulinemia.
