title: Rapid Deterioration of the Renal Function Caused by the Coexistence of Intratubular Amyloidosis and Myeloma Cast Nephropathy.
abstract: Multiple myeloma presents with various kidney injuries, including cast nephropathy, light chain deposition disease, and amyloidosis. Cast nephropathy is the most common form and mostly consists of monoclonal immunoglobulin light chains with Tamm-Horsfall protein. Immunoglobulin light chain (AL) amyloidosis may affect all compartments of the kidney, but it is rare in the tubuli. We herein present a rare case with rapid progression of renal failure caused by the co-occurrence of intratubular amyloidosis and cast nephropathy due to multiple myeloma. Our case suggests unique amyloidogenic light chain cast, which can form amyloid fibrils under specific tubular fluid conditions, and illustrates the complicated light chain pathophysiology.
authors.affiliation: Department of Internal Medicine, Teikyo University School of Medicine, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kato
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujigaki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Asakawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uozaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komatsuda
authors.forename: Michio
authors.initials: M
authors.lastname: Nagata
authors.forename: Shunya
authors.initials: S
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols; D003404:Creatinine / Q000378:metabolism*; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000378:metabolism*; D000075363:Immunoglobulin Light-chain Amyloidosis; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D010265:Paraproteinemias / Q000150:complications; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000682:Amyloid; D007147:Immunoglobulin Light Chains; D003404:Creatinine