Gülay BULUT, Mustafa KÖSEM

Acute renal failure due to light chain cast nephropathy (A Case Report)

Abstract. Myeloma cast nephropathy, also known Bence Jones cast nephropathy or myeloma kidney is the most common form of renal disease associated with multiple myeloma. Clinically, it may present as progressive renal insufficieny or acute renal failure. We describe a case of multiple myeloma who presented with acute renal failure due to light chain cast nephropathy and had a primary diagnosis made by renal biopsy. A renal biopsy was performed for acute renal failure in a 44 year old female patient. The renal biopsy showed numerous dilated tubules filled with pink eosinophilic fractured casts surrounded at places by multinucleated giant cells and accompanied by moderate interstitial infiltrate consisting of lymphomononuclear cells. There was tubular atrophy with interstitial fibrosis. The renal biopsy is occasionally the first test indicative of myeloma in a patient with acute renal failure of seemingly unknown origin. Thus the microscopic appearance of the tubules in this biopsy is easy to appreciate and is diagnostic of light chain cast nephropathy.Key words: Multiple myeloma, light chain cast nephropathy, acute renal failure

Keywords:

Multiple myeloma light chain cast nephropathy, acute renal failure,

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Hiromura K, Nojima Y. Renal disease in multiple myeloma. Nippon Rinsho 2007; 65: 2229-2234.
Sakhuja V, Jha V, Varma S, et al. Renal involvement in multiple myeloma: a 10-year study. Ren Fail 2000; 22: 465-477.
Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21-33.
Felix DR, Giralt M, Giraldo MP. Nonsecretory multiple myeloma. Cancer 1987; 59: 1847-1852.
Osserman EF, Takatsuki K. Plasma cell myeloma: Gammaglobulin synthesis and structure. Med Baltimore 1963; 42: 357-384.
Abdalla IA, Tabbara IA. Nonsecretory multiple myeloma. South Med J 2002; 95: 761-764.
Cohen AH, Nast CC. The Kidney. In: Damjanov I, Linder J (eds). Anderson’s Pathology (10 th ed). St Louis, MO, Mosby 1996, pp 2073-2137.
Sanders PW, Herrera GA. Monoclonal immunoglobulin light chain-related renal diseases. Semin Nephrol 1993; 13: 324-341.
Hill GS, Morel-Maroger L, Mery JP, Brouet JC, Mignon F. Renal lesions in multiple myeloma: Their relationship to associated protein abnormalities. Am J Kidney Dis 1983; 2: 423-438.
Gallo GR, Feiner HD, Katz LA. Nodular glomerulopathy associated with non-amyloidotic kappa light chain deposits and excess immunoglobulin light chain synthesis. Am J Pathol 1980; 99: 621-644.
Cohen AH. Morphology of renal tubular hyaline casts. Lab Invest 1981; 44: 280-287.
Cohen AH, Border WA. Myeloma kidney:An immunomorphogenetic study of renal biopsies. Lab Invest 1980; 42: 248-256.
Cohen AH. The pathogenesis of cast nephropathy. In: Minetti L, D’Amico G, Ponticelli C (eds). The Kidney in Plasma Cell Dyscrasias. Dordrecht, The Netherlands, Kluwer Academic 1988, pp 123-131.
Border WA, Cohen AH. Renal biopsy diagnosis of clinically silent multipl myeloma. Ann Intern Med. 1980; 93: 43-46.