{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T10:00:11Z","timestamp":1762941611103,"version":"3.45.0"},"reference-count":20,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,25]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>We report the case of a woman in her late 70s with frailty and treatment-resistant hypertension who presented with marked albuminuria, purpuric rash and elevated serum free light chains. Renal biopsy confirmed monoclonal gammopathy of renal significance (MGRS) with Type I cryoglobulinaemia. She was treated with bortezomib and dexamethasone, resulting in clinical and biochemical remission. However, she experienced a relapse within months, requiring re-initiation of therapy with additional agents. Despite supportive measures, she later developed complications of infection and fluid overload, which proved fatal. This case illustrates the importance of timely diagnosis and initiation of clone-directed therapy in MGRS with organ-threatening features. Comprehensive geriatric assessment played a key role in individualising treatment, anticipating toxicity and preserving function, while the course also highlights the difficulties of relapse management in older patients.<\/jats:p>","DOI":"10.1136\/bcr-2025-268524","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T09:55:13Z","timestamp":1762941313000},"page":"e268524","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Monoclonal gammopathy of renal significance presenting as cryoglobulinaemic vasculitis in a frail elderly patient"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6540-6100","authenticated-orcid":false,"given":"Venugopal","family":"Mantry","sequence":"first","affiliation":[{"name":"Department of Geriatric Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6115-7962","authenticated-orcid":false,"given":"Swarup","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akshata","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinash","family":"Chakrawarty","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"2025111201550775000_18.11.e268524.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-07-445304"},{"key":"2025111201550775000_18.11.e268524.2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12882-024-03458-5","article-title":"Systematic review and meta-analysis of the clinical features of monoclonal gammopathy of renal significance (MGRS)","volume":"25","author":"Du","year":"2024","journal-title":"BMC Nephrol"},{"key":"2025111201550775000_18.11.e268524.3","first-page":"39","article-title":"Monoclonal gammopathy of renal significance: a consensus report","volume":"32","author":"Sethi","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"2025111201550775000_18.11.e268524.4","first-page":"1002","article-title":"Cryoglobulinemia","volume":"384","author":"Cacoub","year":"2021","journal-title":"N Engl J Med"},{"key":"2025111201550775000_18.11.e268524.5","unstructured":"Killeen RB , Awais M , Mikes BA . Cryoglobulinemia. Treasure Island (FL): StatPearls Publishing,"},{"key":"2025111201550775000_18.11.e268524.6","unstructured":"StatPearls contributors . Cryoglobulinaemic glomerulonephritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"2025111201550775000_18.11.e268524.7","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23608"},{"key":"2025111201550775000_18.11.e268524.8","first-page":"2040620719845904","article-title":"Special considerations for the treatment of multiple myeloma according to advanced age, comorbidities, frailty and organ dysfunction","volume":"10","author":"Dimopoulos","year":"2019","journal-title":"Ther Adv Hematol"},{"key":"2025111201550775000_18.11.e268524.9","first-page":"21152","article-title":"Clinicopathologic characteristics and prognostic analysis of monoclonal gammopathy of renal significance (MGRS) in patients with IgM monoclonal gammopathy: a case series","volume":"12","author":"Xu","year":"2022","journal-title":"Sci Rep"},{"key":"2025111201550775000_18.11.e268524.10","unstructured":"D\u2019Agati VD , Bomback AS . Cryoglobulinaemic vasculitis. In: Jennette JC , Olson JL , Silva FG , et al , eds. Heptinstall\u2019s pathology of the kidney. Philadelphia: Wolters Kluwer, 2015: 1083\u2013120."},{"key":"2025111201550775000_18.11.e268524.11","first-page":"1239","article-title":"Clinicopathologic correlations in cryoglobulinaemic glomerulonephritis","volume":"7","author":"Nasr","year":"2012","journal-title":"Clin J AmSoc Nephrol"},{"key":"2025111201550775000_18.11.e268524.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00464-7"},{"key":"2025111201550775000_18.11.e268524.13","first-page":"1757","article-title":"Geriatric assessment with management intervention in older adults with cancer (GAP70+): a single-blind, cluster-randomised clinical trial","volume":"22","author":"Mohile","year":"2021","journal-title":"Lancet Oncol"},{"key":"2025111201550775000_18.11.e268524.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.12.030"},{"key":"2025111201550775000_18.11.e268524.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa01133202"},{"key":"2025111201550775000_18.11.e268524.16","doi-asserted-by":"crossref","unstructured":"Waxman AJ , Clasen Lin Z , Sher T , et al . Carfilzomib-associated cardiovascular adverse events: a systematic review and metaanalysis. JAMA Oncol 2018;4. doi:10.1001\/jamaoncol.2017.4519","DOI":"10.1001\/jamaoncol.2017.4519"},{"key":"2025111201550775000_18.11.e268524.17","unstructured":"Goli R , Rajashekar R , Deepthi K . Type 1 cryoglobulinemia associated with monoclonal gammopathy of renal significance. 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