Cold Agglutinin Disease and the Nephrotic Syndrome

Abstract

A 66-year-old woman entered the hospital with both chronic, idiopathic cold agglutinin disease, manifested primarily by severe hemolytic anemia, and the nephrotic syndrome. The cold agglutinin was unusual in that it was cryoprecipitable, had a very wide thermal amplitude, and possessed intense hemolytic activity. The usual causes of the nephrotic syndrome were absent and postmortem examination revealed normal-appearing glomeruli. We suggest that the IgM cold agglutinin, alone or in combination with serum complement, was etiologically related to the induction of the nephrotic syndrome via attack on the glomerular basement membrane. Treatment with chlorambucil did not significantly alter the patient's hematologic or renal disorders.