Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2021.328
Autopsy and Case Reports
Clinical Case Report

Multiple myeloma presenting as acute tubulointerstitial nephritis

Ying Long; Abed A. Aljamal; Hisham F. Bahmad; Niharika Yedla; Guillermo A. Herrera; Michael A. Schwartz; Ayman Layka

Downloads: 0
Views: 79

Abstract

Background: Acute tubulointerstitial nephritis (ATIN) is a very rare paraneoplastic manifestation in patients with multiple myeloma (MM). It is an uncommon pattern of renal disease in such patients.

Case presentation: We report a case of an 82-year-old male who was admitted with acute kidney injury. Renal biopsy showed typical findings of light chain-associated ATIN with scattered inflammatory cells in the interstitium and associated active tubulitis. No other common manifestations of MM were present at the time of presentation, including hypercalcemia, hyperuricemia, proteinuria, bone pain or lytic bone lesions. Subsequent immunoassays revealed significant serum lambda light chain burden and Bence Jones protein in urine. Immunofluorescence demonstrated linear tubular basement membranes with positive staining for lambda light chain (3+). Electron microscopy (EM) further showed interstitial edema and inflammation. All the aforementioned findings are consistent with ATIN and supported the diagnosis of MM.

Conclusions: In conclusion, light chain-associated ATIN should be considered in the differential diagnosis of acute interstitial nephritis. Henceforth, serum free light chains as well as serum and urine protein electrophoresis should be included in the workup of such patients.

Keywords

Case Reports, Multiple Myeloma, Nephritis, Interstitial, Microscopy, Electron

References

1 Kumar, SK, Rajkumar, V, Kyle, RA, et al. Multiple myeloma. Nat Rev Dis Primers. 2017;3(1):17046. http://dx.doi.org/10.1038/nrdp.2017.46.

2 Kazandjian D. Multiple myeloma epidemiology and survival: a unique malignancy. Semin Oncol. 2016;43(6):676-81. http://dx.doi.org/10.1053/j.seminoncol.2016.11.004. PMid:28061985.

3 Rajkumar SV. Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016;91(7):719-34. http://dx.doi.org/10.1002/ajh.24402. PMid:27291302.

4 Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33. http://dx.doi.org/10.4065/78.1.21. PMid:12528874.

5 Knudsen LM, Hippe E, Hjorth M, Holmberg E, Westin J. Renal function in newly diagnosed multiple myeloma--a demographic study of 1353 patients. The Nordic Myeloma Study Group. Eur J Haematol. 1994;53(4):207-12. http://dx.doi.org/10.1111/j.1600-0609.1994.tb00190.x. PMid:7957804.

6 Ardalan MR, Shoja MM. Multiple myeloma presented as acute interstitial nephritis and rheumatoid arthritis-like polyarthritis. Am J Hematol. 2007;82(4):309-13. http://dx.doi.org/10.1002/ajh.20796. PMid:17022047.

7 Hutchison CA, Batuman V, Behrens J, et al. The pathogenesis and diagnosis of acute kidney injury in multiple myeloma. Nat Rev Nephrol. 2011;8(1):43-51. http://dx.doi.org/10.1038/nrneph.2011.168. PMid:22045243.

8 Haynes RJ, Read S, Collins GP, Darby SC, Winearls CG. Presentation and survival of patients with severe acute kidney injury and multiple myeloma: a 20-year experience from a single centre. Nephrol Dial Transplant. 2010;25(2):419-26. http://dx.doi.org/10.1093/ndt/gfp488. PMid:19767634.

9 Sprangers B. Aetiology and management of acute kidney injury in multiple myeloma. Nephrol Dial Transplant. 2018;33(5):722-4. http://dx.doi.org/10.1093/ndt/gfy079. PMid:29718422.

10 Gu X, Herrera GA. Light-chain-mediated acute tubular interstitial nephritis: a poorly recognized pattern of renal disease in patients with plasma cell dyscrasia. Arch Pathol Lab Med. 2006;130(2):165-9. http://dx.doi.org/10.5858/2006-130-165-LATINA. PMid:16454555.

11 Herrera GA. Proximal tubulopathies associated with monoclonal light chains: the spectrum of clinicopathologic manifestations and molecular pathogenesis. Arch Pathol Lab Med. 2014;138(10):1365-80. http://dx.doi.org/10.5858/arpa.2013-0493-OA. PMid:25268200.

12 Yadav, P, Sathick, IJ, Leung, N, et al. Serum free light chain level at diagnosis in myeloma cast nephropathy—a multicentre study. Blood Cancer J. 2020;10(3):28. http://dx.doi.org/10.1038/s41408-020-0295-4.

13 Nangaku M. Mechanisms of tubulointerstitial injury in the kidney: final common pathways to end-stage renal failure. Intern Med. 2004;43(1):9-17. http://dx.doi.org/10.2169/internalmedicine.43.9. PMid:14964574.

14 Leung N, Bridoux F, Batuman V, et al. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol. 2019;15(1):45-59. http://dx.doi.org/10.1038/s41581-018-0077-4. PMid:30510265.
 


Submitted date:
06/27/2021

Accepted date:
08/09/2021

Publication date:
09/23/2021

614cc642a95395384a3f2642 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections