医学
肾小管病变
免疫球蛋白轻链
多发性骨髓瘤
肾病
病理
尿
肾活检
浆细胞失调
肾
链条(单位)
活检
内科学
泌尿科
内分泌学
免疫学
抗体
糖尿病
作者
Gabriel Lerner,Sara Moradi,Abraham Cohen‐Bucay,Hui Chen,Vaishali Sanchorawala,Craig E. Gordon,Joel M. Henderson
出处
期刊:Clinical Nephrology
[Dustri-Verlag Dr. Karl Feistle]
日期:2020-04-01
卷期号:93 (4): 203-208
被引量:5
摘要
Plasma cell dyscrasias, including multiple myeloma (MM), are associated with diverse forms of pathology in the kidney. Some pathologic lesions, including light chain (myeloma) cast nephropathy (LCCN), are relatively common, while others, such as light chain proximal tubulopathy (LCPT), are less so. Both LCCN and LCPT are associated with clinical manifestations of acute kidney injury. Rare instances of coincidental LCPT and LCCN have been reported, but none to our knowledge of coincidental crystalline forms of these diseases, with similar forms appearing in the urine. While LCPT is usually associated with intracytoplasmic deposition of crystallized light chains, the intraluminal light chain casts in LCCN are typically amorphous and do not form crystals. We report here the co-occurrence of these two monoclonal crystalline forms of acute kidney injury in a 66-year-old woman with known history of κ-restricted multiple myeloma. Additionally, forms suggestive of a crystalline morphology were observed in the urine sediment. Clinicians who observe similar crystalline structures on renal biopsy or in urine sediment should have a high index of suspicion for underlying multiple myeloma as a unifying diagnosis.
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