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NDT Plus Advance Access published online on September 24, 2009
NDT Plus, doi:10.1093/ndtplus/sfp140
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A case of bilateral renal arterial thrombosis associated with cryocrystalglobulinaemia

Nelson Leung1, Francis K. Buadi2, Kevin W. Song3, Alexander B. Magil4 and Lynn D. Cornell5

1 Division of Nephrology and Hypertension
2 Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
3 Division of Hematology, Vancouver General Hospital
4 Department of Pathology and Laboratory Medicine, St Paul's Hospital, Vancouver, BC, Canada
5 Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, MN, USA

Correspondence: Nelson Leung; E-mail: leung.nelson{at}mayo.edu


  Abstract

Cryocrystalglobulinaemia is an extremely rare complication of monoclonal gammopathy. Its presentation has features of both type I and II cryoglobulinaemia. Although peripheral and digital ischaemia is common, visceral ischaemia is rare. When it does occur, it is usually associated with multiple myeloma and has an extremely poor prognosis. We present a case of bilateral renal artery thrombosis associated with cryocrystalglobulinaemia in a patient without myeloma. More unusual, the cryocrystal protein in this case was associated with fibrinogen, which may have led to increased propensity towards thrombosis. Although the patient was unable to recover his kidney function, he remained alive on dialysis 2 years after the incident. The patient did not have any further ischaemic event despite no definitive therapy. This case represents an unusual presentation for this rare disease.

Key Words: cryocrystalglobulinaemia • crystal • monoclonal • renal artery thrombosis

Received for publication August 12, 2009. Accepted for publication August 31, 2009.


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