Korean J Nephrol.  2005 Jul;24(4):638-643.

A Case of Mesangial Proliferative Glomerulonephritis Presented with Acute Renal Failure in Patients with lambda Light Chain Type-Multiple Myeloma

• Shin HS
• Eo WK
• Jung YS
• Rim H
• Chun BK
• Kim MH

Abstract

A 44-year-old male was admitted because of nausea and fatigue. At admission, renal insufficiency was disclosed (serum BUN 94 mg/dL, Cr 8.4 mg/ dL). Serum protein electrophoresis was normal. Urine electrophoresis showed non-selective proteinuria with M component in gamma globulin fraction. Serum immunoelectrophoresis disclosed a predominance of free lambda chain protein. Bone marrow aspiration showed a heavy infiltration of immature plasma cells. Percutaneous renal biopsy showed 9 of 10 glomeruli were slightly increased in size. Cellularity and area of mesangium were also increased. Immunohistochemical staining of kappa and lambda light chain was negative. Electron microscopy showed sparse electron dense deposits with no deposition of amyloid-like fibrils in mesangial area. In summary, these finding were compatible with those of mesangial proliferative glomerulonephritis with acute renal failure associated with multiple myeloma (lambda light chain type). There was no published report like this case. Although serum creatinine decreased to 2.1 mg/dL following steroid-pulse therapy, renal function came to deteriorate again after a month of discharge. Permanent hemodialysis was applied.

Keyword

Multiple myeloma; Light chain deposition disease; Acute renal failure; Glomerulonephritis

MeSH Terms

Acute Kidney Injury*
Adult
Biopsy
Bone Marrow
Creatinine
Electrophoresis
Fatigue
gamma-Globulins
Glomerulonephritis*
Humans
Immunoelectrophoresis
Male
Microscopy, Electron
Multiple Myeloma
Nausea
Plasma Cells
Proteinuria
Renal Dialysis
Renal Insufficiency
Creatinine
gamma-Globulins