Isolated Renal Involvement by IG4-Related Disorder Mimicking Multiple Myeloma, a Diagnosis Not to Miss

Abstract Aims Multiple myeloma (MM) is a malignant neoplasm with a frequent cardiac involvement characterized by restrictive cardiomyopathy. Kidney and thromboembolic complications are also described. Methods and results A 52-year-old woman with a history of kidney disease was admitted to nephrology department due to worsening of renal function and refractory hypertension. A bone marrow biopsy revealed the diagnosis of MM. A renal and fat pad biopsy with Congo red staining was performed but amyloid deposition was not observed. Increased cardiac enzymes suggested a cardiac involvement. Indeed, two intracardiac right-sided masses and massive pulmonary embolism were detected. Surgical cardiac intervention was promptly performed and a chemotherapy regimen was started. Meantime, a kidney biopsy revealed a light-chain deposition disease. Conclusions This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, in patients with not acute massive pulmonary embolism and intracardiac right masses, surgical pulmonary embolectomy should be promptly performed to preserve RV function and to avoid prevent pulmonary hypertension development.

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A “double-seropositive” Vasculitis for antiglomerular basement membrane antibodies and antineutrophil cytoplasmic antibody, and multiple myeloma, all three with simultaneous diagnosis of renal involvement, common pathophysiology, or pure coincidence? first case in the World

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.265473 ◽

2019 ◽

Vol 30 (4) ◽

pp. 953 ◽

Cited By ~ 1

Author(s):

Mariam Chettati ◽

Adil Adnouni ◽

Nadia Bouchemla ◽

Sara Anibar ◽

Wafaa Fadili ◽

...

Keyword(s):

Multiple Myeloma ◽

Basement Membrane ◽

Renal Involvement ◽

Antineutrophil Cytoplasmic Antibody ◽

First Case ◽

The World

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Renal involvement as the first symptom of multiple myeloma

10.21203/rs.2.10471/v2 ◽

2019 ◽

Author(s):

Yongjing Du ◽

Ping Zhang ◽

Xiang Zhong ◽

Shasha Chen ◽

Guisen Li ◽

...

Keyword(s):

Multiple Myeloma ◽

Renal Failure ◽

Nephrotic Syndrome ◽

Light Chain ◽

Clinical Laboratory ◽

Renal Involvement ◽

Clinical Manifestations ◽

Renal Amyloidosis ◽

Cast Nephropathy ◽

Immunofixation Electrophoresis

Abstract Background . Renal involvement is a common complication of multiple myeloma (MM). However, most studies have focused on renal failure in MM, and little information is available about the other renal manifestations in MM and their association with immunophenotypes and renal pathology. Methods . We retrospectively analyzed the clinical, laboratory and pathology data of 283 MM patients treated in Sichuan Provincial People’s Hospital, West China, between January 1990 and May 2017. The patients were divided into a renal involvement group (n = 200) and a non-renal involvement group (n = 83). Results. In the renal involvement group, 90 (45.0%) patients were diagnosed with MM in the Nephrology department, and isolated proteinuria, renal failure and nephrotic syndrome were detected in 90(45.0%), 94 (47.0%) and 58 (29.0%) patients, respectively. 135 patients with renal involvement underwent immunofixation electrophoresis, and IgG, IgA, IgD, IgE, pure light chain and nonsecretory MM were detected in 52 (38.5%), 32 (23.7%), 1 (0.7%), 1 (0.7%), 45(33.3%) and 4 (3.0%) patients, respectively. 47 patients without renal involvement also underwent immunofixation electrophoresis, and IgG and IgA MM were found in 24 (51.0%) and 18 (38.3%) patients, respectively. Severe anemia and hypertension, hypercalcemia and pure light chain were more frequent in patients with renal involvement (P < 0.05).9 patients with renal involvement were performed renal biopsy, and cast nephropathy, renal amyloidosis were proved in 5 and 4 patients, respectively. Conclusions. Renal involvement was common at MM diagnosis and had diverse clinical manifestations. The most common clinical manifestations include renal failure, isolated albuminuria and nephrotic syndrome. Nephrologists should rule out MM in patients presenting with renal involvement.

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Renal involvement as the first symptom of multiple myeloma

10.21203/rs.2.10471/v1 ◽

2019 ◽

Author(s):

Yongjing Du ◽

Ping Zhang ◽

Xiang Zhong ◽

Shasha Chen ◽

Guisen Li ◽

...

Keyword(s):

Multiple Myeloma ◽

Renal Failure ◽

Light Chain ◽

Clinical Laboratory ◽

Renal Involvement ◽

Clinical Manifestations ◽

Renal Amyloidosis ◽

Cast Nephropathy ◽

Light Chain Disease ◽

Immunofixation Electrophoresis

Abstract Background Renal involvement is a common complication of multiple myeloma (MM). However, most studies have focused on renal failure in MM, and little information is available about the other renal manifestations in MM and their association with immunophenotypes and renal pathology. Methods We retrospectively analyzed the clinical, laboratory and pathology data of 283 MM patients treated in Sichuan Provincial People’s Hospital, West China, between January 1990 and May 2017. The patients were divided into a renal involvement group (n = 200) and a non-renal involvement group (n = 83). Results In the renal involvement group, 90 (45.0%) patients were diagnosed with MM in the Nephrology department, and isolated proteinuria, renal failure and nephrotic syndrome were detected in 90(45.0%), 94 (47.0%) and 53 (27.0%) patients, respectively. 135 patients with renal involvement underwent immunofixation electrophoresis, and IgG, IgA, IgD, IgE, pure light chain and nonsecretory MM were detected in 52 (38.5%), 32 (23.7%), 1 (0.7%), 1 (0.7%), 45(33.3%) and 4 (3.0%) patients, respectively. 47 patients without renal involvement also underwent immunofixation electrophoresis, and IgG and IgA MM were found in 24 (51.0%) and 18 (38.3%) patients, respectively. Severe anemia and hypertension, hypercalcemia and pure light chain disease were more frequent in patients with renal involvement (P < 0.05). 9 patients with renal involvement were performed renal biopsy, and cast nephropathy and renal amyloidosis were proved in 5(55.6%) and 4(44.4%) patients, respectively. Conclusions Renal involvement was common at MM diagnosis and had diverse clinical manifestations. Nephrologists should rule out MM in patients presenting with renal involvement.

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P0259PARAPROTEIN-RELATED RENAL LESIONS IN NEWLY DIAGNOSED MULTIPLE MYELOMA: CLINICAL AND PATHOLOGICAL CHARACTERISTIC OF 51 PATIENTS WITH KIDNEY BIOPSIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0259 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Zishan Lin ◽

Xiaojuan Yu ◽

Suxia Wang ◽

Xinan Cen ◽

Fude Zhou ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Renal Involvement ◽

Laboratory Data ◽

Lower Percentage ◽

Newly Diagnosed ◽

Light Chain Deposition Disease ◽

Renal Lesions ◽

Common Diagnosis ◽

Male Sex

Abstract Background and Aims Renal involvement is common in multiple myeloma (MM). In this study, we examined kidney biopsy findings in patients with newly diagnosed MM (NDMM) and correlated them with clinical characteristics and survival. Method Renal pathological findings were retrospectively studied in 56 patients with NDMM. Clinical and laboratory data as well as outcomes were collected from 51 patients with paraprotein-related renal lesions in NDMM. Patients were categorized according to the with or without myeloma cast nephropathy (MCN). Results Among 56 patients with NDMM, 51 had paraprotein-related renal lesions, of which MCN was the most common lesion in 31 patients (60.8%), followed by amyloidosis in 12 patients (23.5%) and light chain deposition disease (LCDD) in 8 patients (15.7%). Five patients had nonparaprotein-associated lesions, of which minimal change disease was the most common diagnosis, seen in 3 patients (60%). Patients with MCN had significantly higher serum creatinine levels, a lower eGFR, a higher percentage of requiring dialysis at diagnosis, a higher incidence of progressing to end-stage renal disease (ESRD), lower hemoglobin levels, a lower percentage of albumin in urine protein, a higher level of serum albumin and were more likely to have a detectable M-spike but less likely to have a detectable monoclonal whole immunoglobulin than patients without MCN. Compared with patients with MCN, the median overall survival time of patients without MCN was significantly longer (not reached vs 39 months (95% CI: 9–69 months); P=0.047; Fig.1). According to the multivariate analysis, the independent predictors of overall survival were the number of myeloma casts (HR: 1.12, 95% CI: 1.07-1.25; P=0.014) and male sex (HR: 4.99, 95% CI: 1.36-18.38; P=0.016). Conclusion Patients with MCN suffer from more serious and more urgent renal damage and can also present with high-grade albuminuria but without hypoalbuminemia. The number of myeloma casts and male sex are independent predictors of overall survival.

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Renal involvement in multiple myeloma

Polish Archives of Internal Medicine ◽

10.20452/pamw.1385 ◽

2012 ◽

Vol 122 (9) ◽

pp. 443-448

Author(s):

Tomasz Stompór ◽

Marek Zabłocki ◽

Katarzyna Pankrac

Keyword(s):

Multiple Myeloma ◽

Renal Involvement

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