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Case 132
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Diagnosis: Myeloma Cast Nephropathy

Bone marrow study demonstrated aberrant monoclonal population of plasm cells, with lambda light chain expression.

The term myeloma kidney or myeloma cast nephropathy refers to a disorder in which monoclonal urinary immunoglobulin light chains lead to acute or chronic renal failure. The diagnosis of light chain cast nephropathy indicates the presence of multiple myeloma; in other words, it is considered a "myeloma-defining event". Light chain cast nephropathy can occur as the first manifestation of myeloma or can develop later during the course of myeloma (Appel GB, Leung N, Rajkumar SV. Pathogenesis and diagnosis of myeloma cast nephropathy (myeloma kidney) (In UpToDate. Visited on January 20th, 2016. [Link]).

See the chapter: Amyloidosis, multiple myeloma... of our Tutorial.

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References

  • Leung N. To biopsy or not to biopsy, that is the question in myeloma cast nephropathy. Nephrol Dial Transplant. 2016;31(1):1-3. [PubMed link]
  • Ecotière L, Thierry A, Debiais-Delpech C, Chevret S, Javaugue V, Desport E, Belmouaz S, Quellard N, Kaaki S, Goujon JM, Fermand JP, Touchard G, Bridoux F. Prognostic value of kidney biopsy in myeloma cast nephropathy: a retrospective study of 70 patients. Nephrol Dial Transplant. 2016;31(1):64-72. [PubMed link]
  • Zand L, Nasr SH, Gertz MA, Dispenzieri A, Lacy MQ, Buadi FK, Kumar S, Kyle RA, Fervenza FC, Sethi S, Dingli D, Rajkumar SV, Kapoor P, McCurdy A, Leung N. Clinical and prognostic differences among patients with light chain deposition disease, myeloma cast nephropathy and both. Leuk Lymphoma. 2015;56(12):3357-64. [PubMed link]
  • Walther C, Podoll AS, Finkel KW. Treatment of acute kidney injury with cast nephropathy. Clin Nephrol. 2014;82(1):1-6. [PubMed link]

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