Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone
Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent...
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2012-12-01
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doaj-c0fd9326089446209601bff8bab0f8292020-11-24T23:23:10ZengNepal Medical AssociationJournal of Nepal Medical Association0028-27151815-672X2012-12-0152188378Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and DexamethasoneR Hada0B Poudyal1A Sharma2R Khatri3Department of Nephrology, National Academy of Medical Sciences, Bir Hospital and Blue Cross Hospital, Kathmandu,Department of Clinical Haematology, Civil Service Hospital and Blue Cross Hospital, KathmanduDepartment of Histopathology, National Reference Laboratory, Dr Lal Path Labs Pvt Ltd, New DelhiDepartment of Medicine, Shree Birendra Hospital and Blue Cross Hospital, KathmanduCast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment. We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy. Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma.http://jnma.com.np/jnma/index.php/jnma/article/view/378 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
R Hada B Poudyal A Sharma R Khatri |
spellingShingle |
R Hada B Poudyal A Sharma R Khatri Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone Journal of Nepal Medical Association |
author_facet |
R Hada B Poudyal A Sharma R Khatri |
author_sort |
R Hada |
title |
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone |
title_short |
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone |
title_full |
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone |
title_fullStr |
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone |
title_full_unstemmed |
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone |
title_sort |
lambda light chain myeloma with oliguric cast nephropathy and remission with bortezomib, doxorubicin and dexamethasone |
publisher |
Nepal Medical Association |
series |
Journal of Nepal Medical Association |
issn |
0028-2715 1815-672X |
publishDate |
2012-12-01 |
description |
Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment.
We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.
Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma. |
url |
http://jnma.com.np/jnma/index.php/jnma/article/view/378 |
work_keys_str_mv |
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