Junhui Xu1, Xiaojuan Yu2, Suxia Wang3, Miao Yan1, Mangju Wang1, Jinping Ou1, Lihong Wang1, Huihui Liu1, Xinan Cen4. 1. Department of Hematology, Peking University First Hospital, No.8 Xi Shi Ku Street, Xi ChengDistrict, Beijing, 100034, China. 2. Department of Nephrology, Peking University First Hospital, Beijing, China. 3. Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, China. 4. Department of Hematology, Peking University First Hospital, No.8 Xi Shi Ku Street, Xi ChengDistrict, Beijing, 100034, China. cenxn@bjmu.edu.cn.
Abstract
BACKGROUND: Multiple myeloma causes different types of renal injury. C3 glomerulonephritis (C3GN) is characterised by an abnormal deposition of complement C3 in the glomeruli due to abnormal activation of the alternative pathway of the complement system. While the association between C3GN and multiple myeloma has been well established, mild renal injury by C3GN in multiple myeloma patients with high levels of light chain has not been reported. CASE PRESENTATION: A 55-year-old Chinese man presented with proteinuria. Combined with immunofixation electrophoresis, bone marrow biopsy, and renal biopsy, he was diagnosed with IgA-type multiple myeloma accompanied by C3GN and light chain proximal tubulopathy without crystal deposits. Although he had a higher level of lambda serum-free light chain, the renal injury in this patient was mild. After treatment with four courses of BD, one course of PAD, and autologous stem cell transplantation, he achieved a very good partial hematologic response with stable renal function. CONCLUSIONS: In multiple myeloma, the light chain reaches a certain level and persists, resulting in C3GN renal impairment. Early diagnosis and early intensive treatment are critical for the prognosis of such patients.
BACKGROUND:Multiple myeloma causes different types of renal injury. C3 glomerulonephritis (C3GN) is characterised by an abnormal deposition of complement C3 in the glomeruli due to abnormal activation of the alternative pathway of the complement system. While the association between C3GN and multiple myeloma has been well established, mild renal injury by C3GN in multiple myelomapatients with high levels of light chain has not been reported. CASE PRESENTATION: A 55-year-old Chinese man presented with proteinuria. Combined with immunofixation electrophoresis, bone marrow biopsy, and renal biopsy, he was diagnosed with IgA-type multiple myeloma accompanied by C3GN and light chain proximal tubulopathy without crystal deposits. Although he had a higher level of lambda serum-free light chain, the renal injury in this patient was mild. After treatment with four courses of BD, one course of PAD, and autologous stem cell transplantation, he achieved a very good partial hematologic response with stable renal function. CONCLUSIONS: In multiple myeloma, the light chain reaches a certain level and persists, resulting in C3GN renal impairment. Early diagnosis and early intensive treatment are critical for the prognosis of such patients.
Authors: Punit Yadav; Paul Cockwell; Mark Cook; Jennifer Pinney; Hannah Giles; Yu Sandar Aung; David Cairns; Roger G Owen; Faith E Davies; Graham H Jackson; J Anthony Child; Gareth J Morgan; Mark T Drayson Journal: BMC Nephrol Date: 2018-07-13 Impact factor: 2.388