title: IgA-kappa type multiple myeloma affecting proximal and distal renal tubules.
abstract: A 45-year-old male was admitted because of chest pain, lumbago, and bilateral ankle pain. Examination disclosed hypophosphatemic osteomalacia, acquired Fanconi syndrome, and abnormalities in distal nephron such as distal renal tubular acidosis and renal diabetes insipidus. Further exploration revealed IgA kappa multiple myeloma excreting urinary Bence Jones protein (kappa-light chain). Renal biopsy revealed thick basement membranes and elec-tron-dense crystals in proximal tubular epithelial cells. Immunofluorescent studies revealed deposition of kappa-light chain in renal tubular epithelial cells that caused the renal tubular damage. Although the osteomalacia was relieved by medical treatment, the urinary Bence Jones protein and the renal tubular defects were not improved by the chemotherapy for the myeloma. The patient died of exacerbation of multiple myeloma at 50 years of age.
authors.affiliation: Department of Aging Medicine and Geriatrics, Shinshu University School of Medicine, Matsumoto.
authors.forename: K
authors.initials: K
authors.lastname: Minemura
authors.forename: K
authors.initials: K
authors.lastname: Ichikawa
authors.forename: N
authors.initials: N
authors.lastname: Itoh
authors.forename: N
authors.initials: N
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Hara
authors.forename: S
authors.initials: S
authors.lastname: Shigematsu
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: K
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: K
authors.initials: K
authors.lastname: Hashizume
mesh_terms: D001706:Biopsy; D017809:Fatal Outcome; D006801:Humans; D007070:Immunoglobulin A; D007145:Immunoglobulin kappa-Chains; D007668:Kidney / Q000378:metabolism* / Q000473:pathology; D007680:Kidney Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D007686:Kidney Tubules, Distal / Q000473:pathology*; D007687:Kidney Tubules, Proximal / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D010018:Osteomalacia / Q000209:etiology; D013997:Time Factors
chemical_list: D007070:Immunoglobulin A; D007145:Immunoglobulin kappa-Chains