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Unusual manifestation of monoclonal gammopathy of undetermined significance: a false serum creatinine elevation

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Abstract

A 72-year-old Japanese man with diabetes mellitus and hypertension presented with an acutely elevated serum creatinine level, from 1.02 to 4.13 mg/dL over 2 months as measured by the enzymatic method by pure-auto S CRE-N®. Renal biopsy could not identify the etiology of the elevating sCr. However, an elevated total protein level (8.2 g/dL) and lowering of the BUN and sCr ratio from 14.5 to 2.7 were found, and bone marrow biopsy showed less than 10% lymphoplasmacytic infiltration, compatible with monoclonal gammopathy of undetermined significance. The diagnosis of a false serum creatinine elevation due to monoclonal gammopathy of undetermined significance was confirmed with the serum cystatin C level at 1.05 mg/dL and the creatinine level of 0.97 mg/dL using Shikarikid-S CRE® method. Although cases of monoclonal gammopathy of undetermined significance with a false serum creatinine elevation as an initial presentation are rare, this condition should be considered in patients with paraproteinemia; measuring the renal function using cystatin C is important in such patients.

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References

  1. Kyle RA. Monoclonal gammopathy of undetermined significance: natural history in 241 cases. Am J Med. 1987;64:814–26.

    Article  Google Scholar 

  2. Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Melton LJ III. Long-term follow-up of 241 patients with monoclonal gammopathy of undetermined significance: the original Mayo Clinic series 25 years later. Mayo Clin Proc. 2004;79:859–66.

    Article  Google Scholar 

  3. Kyle RA, Larson DR, Therneau TM, Despenzieri A, Kumar S, Cerhan JR. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med. 2018;378:241–9.

    Article  CAS  Google Scholar 

  4. Rajkumar SV. Plasma cell disorders. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Philadelphia: Elsevier Saunders; 2016. p. 1273–1284.

    Google Scholar 

  5. Berth M, Delanghe J. Protein precipitation as a possible important pitfall in the clinical chemistry analysis of blood samples containing monoclonal immunoglobulins: 2 case reports and a review of the literature. Acta Clin Belg. 2004;59:263–73.

    Article  CAS  Google Scholar 

  6. Pure-auto S CRE-N®. SEKISUI MEDICAL Co., ltd. 2017. https://www.info.pmda.go.jp/tgo/pack/20800AMZ10178000_A_01_07/ Accessed 05 Nov 2019. (in Japanese)

  7. Pure-auto S CRE-L®. SEKISUI MEDICAL Co., ltd. 2017. https://www.info.pmda.go.jp/tgo/pack/21300AMZ00422000_A_01_05/ Accessed 05 Nov 2019. (in Japanese)

  8. Smogorzewska A, Flood JG, Long WH, Dighe AS. Paraprotein interference in automated chemistry analyzers. Clin Chem. 2004;50:1691–3.

    Article  CAS  Google Scholar 

  9. Tsai LY, Tsai SM, Lee SC, Liu SF. Falsely low LDL-cholesterol concentrations and artifactual undetectable HDL-cholesterol measured by direct methods in a patient with monoclonal paraprotein. Clin Chem Acta. 2005;358:192–5.

    Article  CAS  Google Scholar 

  10. Pantanowitz L, Horowitz GL, Upalakalin JN, Beckwith BA. Artifactual hyperbilirubinemia due to paraprotein interference. Arch Pathol Lab. 2003;127:55–9.

    Google Scholar 

  11. Murali MR, Kratz A, Finberg KE. Case records of the Massachusetts General Hospital. Case 40–2006. A 64-year-old man with anemia and a low level of HDL cholesterol. N Engl J Med. 2006;355:2772–9.

    Article  CAS  Google Scholar 

  12. Alyanakian MA, Taes Y, Bensaïd M, Segovia B, Aucouturier P, Rain JD, et al. Monoclonal immunoglobulin with antitransferrin activity: a rare cause of hypersideremia with increased transferrin saturation. Blood. 2007;109:359–61.

    Article  CAS  Google Scholar 

  13. Krish P, Jhaveri KD. Hyperbicarbonatemia in a patient with Waldenstrom's macroglobulinemia Pseudohyperbicarbonatemia due to paraproteinemia. Kidney Int. 2012;81:603–5.

    Article  Google Scholar 

  14. Yang Y, Howanitz PJ, Howanitz JH, Gorfajn H, Wong K. Paraproteins are a common cause of interferences with automated chemistry methods. Arch Pathol Lab Med. 2008;132:217–23.

    CAS  PubMed  Google Scholar 

  15. Miyoshi M, Nishioka M, Hata M, Nakao T, Doi T. Comparative study of measurement error for creatinine concentration in serum six reagents. Jpn J Med Tech. 2017;66:547–53 (in Japanese).

    CAS  Google Scholar 

  16. Yamaki M. A case of pseudohypercreatinemia in a patient suffering from macroglobulinemia. Jpn J Nephrol. 2004;46:43–8 (in Japanese).

    Google Scholar 

  17. Storsley L, Fine A, Krahn J. IgM monoclonal protein presenting as pseudohypercreatinaemia. Nephrol Dial Transplant. 2006;21:3337–8.

    Article  CAS  Google Scholar 

  18. Ikeda M, Tsukamoto T, Miyake T, Kakita H, Komiya T, Yonemoto S, et al. A case of pseudohypercreatinemia associated with monoclonal IgM gammopathy. Jpn J Nephrol. 2013;55:1340–4 (in Japanese).

    CAS  Google Scholar 

  19. Kadatz MJ, Lee ES, Duncan J, Levin A, Johnson O. A peculiar case of Paraproteinemia and elevated creatinine. Am J Kidney Dis. 2018;71:xiv–xv.

    Article  Google Scholar 

  20. Hummel KM, von Ahsen N, Kühn RB, Grunewald RW, Oellerich M, Müller GA. Pseudohypercreatiniemia due to positive interference in enzymatic creatinine measurements caused by monoclonal IgM in patients with Waldenström’s macroglobulinemia. Nephron. 2000;86:188–9.

    Article  CAS  Google Scholar 

  21. Rudofsky G, Villalobos M, Waldherr R, Schair M, Zorn M, Maimer A, et al. Renal failure in a male with Waldenström’s macroglobulinemia. Kidney Int. 2010;77:371–2.

    Article  Google Scholar 

  22. Kwok J, Chow KM, Lit L, Chan M. Paraproteinemia-associated pseudohypercreatinemia across different analytical methodologies. Kidney Int. 2010;78:621.

    Article  Google Scholar 

  23. Sheppard CR, Allen RC, Austin GE, Young AN, Ribeiro MA, Fantz CR. Paraprotein interference in automated chemistry analyzers. Clin Chem. 2005;51:1077–8.

    Article  CAS  Google Scholar 

  24. Reed RG. Interference by an IgM paraprotein in the bromcresol green method for determination of serum albumin. Clin Chem. 1987;33:1075–6.

    Article  CAS  Google Scholar 

  25. Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, et al. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis. 2000;36:29–34.

    Article  CAS  Google Scholar 

  26. Ferguson MA, Waiker SS. Established and emerging markers of kidney function. Clin Chem. 2012;58:680–9.

    Article  CAS  Google Scholar 

  27. Keevil BG, Kilpatrick ES, Nichols SP, Maylor PW. Biological variation of cystatin C: implications for the assessment of glomerular filtration rate. Clin Chem. 1998;44:1535–9.

    Article  CAS  Google Scholar 

  28. Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P, Lindstöm V, et al. Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clin Chem. 1994;40:1921–6.

    Article  CAS  Google Scholar 

  29. Mussap M, Ruzzante N, Varagnolo M, Plebani M. Quantitative automated particle-enhanced immunonephelometric assay for the routine measurement of human cystatin C. Clin Chem Lab Med. 1998;36:859–65.

    Article  CAS  Google Scholar 

  30. Tanaka M, Matsuo K, Enomoto M, Mizuno K. A sol particle homogenous immunoassay for measuring serum cystatin C. Clin Biochem. 2004;37:27–35.

    Article  CAS  Google Scholar 

  31. Tanaka H, Sakuma Y, Ikeda H, Shimizu R, Sugita Y, Iwai R. Characteristics and prognosis of patients with immunoglobulin M monoclonal gammopathy. J Clin Exp Hematop. 2017;57:47–53.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan

    Yoshinosuke Shimamura, Takuto Maeda & Hideki Takizawa

  2. Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan

    Yayoi Ogawa

  3. Department of Hematology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan

    Yuki Nagai

  4. Department of Pathology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan

    Toshiya Shinohara

Authors
  1. Yoshinosuke Shimamura
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  2. Takuto Maeda
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  3. Yayoi Ogawa
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  5. Toshiya Shinohara
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  6. Hideki Takizawa
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Correspondence to Yoshinosuke Shimamura.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number: 2017-125) and followed the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shimamura, Y., Maeda, T., Ogawa, Y. et al. Unusual manifestation of monoclonal gammopathy of undetermined significance: a false serum creatinine elevation. CEN Case Rep 9, 109–113 (2020). https://doi.org/10.1007/s13730-019-00438-9

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  • DOI: https://doi.org/10.1007/s13730-019-00438-9

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