title: Renal failure caused by plasma cell infiltration in multiple myeloma.
abstract: We report on a case of severe renal failure in a 61-year-old female with multiple myeloma (MM). Two months prior to admission, the patient was diagnosed to have anemia and progressive renal failure associated with urinary Bence Jones protein and was referred to our hospital. A bone marrow biopsy revealed 40% plasma cells with κ light chain restriction. Thus, she was considered to have MM. A renal biopsy revealed neoplastic plasma cell infiltration within the kidney, moderate interstitial fibrosis, tubular atrophy, and punctate, electron-dense material along the peripheral capillary walls, tubular basement membrane, and in the interstitium of the kidney. This suggested that a combination of compression of the tubules and the microvasculature by the infiltrative process, and local light chain deposition-mediated tissue damage might be implicated in the development of renal failure in this patient. Despite a remission of bone marrow plasmacytosis with a bortezomib-based regimen, her renal function gradually deteriorated and a periodic hemodialysis program was finally required. Although the clinical impact of the direct kidney infiltration of neoplastic plasma cells on the longitudinal changes in renal function remains to be delineated, it is reasonable to consider that the infiltration of neoplastic plasma cells associated with local light chain depositions may result in irreversible renal injuries. Obviously, further studies and accumulation of additional experience with renal biopsy are required to better determine the precise and prognostic relationship between renal outcome and morphological alterations among MM patients with varying degrees of renal impairment.
authors: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors: Shiho
authors: S
authors: Hanawa
authors: Tetsu
authors: T
authors: Akimoto
authors: Eisuke
authors: E
authors: Uehara
authors: Makoto
authors: M
authors: Inoue
authors: Toshimi
authors: T
authors: Imai
authors: Atsushi
authors: A
authors: Kotoda
authors: Hiromichi
authors: H
authors: Yoshizawa
authors: Tomohiro
authors: T
authors: Matsuyama
authors: Masuzu
authors: M
authors: Ueda
authors: Osamu
authors: O
authors: Saito
authors: Yoshitomo
authors: Y
authors: Hamano
authors: Wako
authors: W
authors: Yumura
authors: Keiya
authors: K
authors: Ozawa
authors: Shigeaki
authors: S
authors: Muto
authors: Eiji
authors: E
authors: Kusano
mesh_terms: D001536:Bence Jones Protein / Q000652:urine; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology*; D011719:Pyrazines / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000209:etiology* / Q000473:pathology
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D001536:Bence Jones Protein