Coincidental crystalline light chain cast nephropathy, light chain proximal tubulopathy, and urine crystallopathy: A case report and review of the literature

被引:8
作者
Lerner, Gabriel [1 ,2 ]
Moradi, Sara [3 ]
Cohen-Bucay, Abraham [4 ]
Chen, Hui [5 ]
Sanchorawala, Vaishali [6 ]
Gordon, Craig E. [7 ]
Henderson, Joel M. [5 ]
机构
[1] Yale New Haven Med Ctr, Dept Pathol, 20 York St, New Haven, CT 06504 USA
[2] Yale New Haven Med Ctr, Dept Lab Med, 20 York St, New Haven, CT 06504 USA
[3] Hartford Hosp, Dept Pathol & Lab Med, Hartford, CT 06115 USA
[4] Natl Inst Med Sci & Nutr Salvador Zubiran, Dept Nephrol & Mineral Metab, Mexico City, DF, Mexico
[5] Boston Med Ctr, Dept Pathol & Lab Med, 670 Albany St,Room 316, Boston, MA 02118 USA
[6] Boston Med Ctr, Dept Med, Sect Hematol & Oncol, Boston, MA 02118 USA
[7] Tufts Med Ctr, Div Nephrol, Dept Med, Boston, MA 02111 USA
关键词
myeloma cast nephropathy; crystalline light chain cast nephropathy; light chain proximal tubulopathy; multiple myeloma; renal pathology; RENAL-FAILURE; MYELOMA; LENALIDOMIDE; AMYLOIDOSIS; DISEASE; LESIONS;
D O I
10.5414/CN109770
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
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.-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.
引用
收藏
页码:203 / 208
页数:6
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