Distal renal tubular acidosis in lymphoplasmacytic lymphoma Waldenström’s macroglobulinemia: a case report

Department of Medical Education, Internal and Preventive Medicine, Griffin Hospital and Yale University School of Medicine USA.
Cases Journal 07/2009; 2:7198. DOI: 10.4076/1757-1626-2-7198
Source: PubMed


We present a case of distal renal tubular acidosis and acute renal insufficiency in a patient with Waldenström's macroglobulinemia. Distal renal tubular acidosis has been described in hypergammaglobulinemia, but not in patients with Waldenström's macroglobulinemia. To our knowledge, this is the first report to describe a possible association between distal renal tubular acidosis and Waldenström's macroglobulinemia. Our case also emphasizes the importance of prompt recognition of distal renal tubular acidosis in patients with Waldenström's macroglobulinemia because of its metabolic disturbances and potentially life threatening complications.

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    ABSTRACT: Nephrogenic diabetes insipidus (DI) is characterized by inability of the kidney to concentrate urine due to diminished renal response to vasopressin. We report a patient with diabetes insipidus and hy-perviscosity as presenting manifestations of Waldenstrom's mac-roglobulinemia. After two treatments with plasmapheresis, serum viscosity normalized and the ability to concentrate urine, polyuria, and polydipsia improved. With ongoing chemoimmunotherapy, he has not had a recurrence of DI. Although rare, nephrogenic DI is a complication of hematologic disorders such as Waldenstrom's mac-roglobulinemia, multiple myeloma and sickle cell anemia.


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