Renal lesions in multiple myeloma: their relationship to associated protein abnormalities

Light chain cast nephropathy and acute renal failure associated with rifampin therapy. Renal disease akin to myeloma kidney

Acute renal failure developed in a patient with a normal serum creatinine level, after treatment with rifampin was begun for tuberculosis. Renal biopsy revealed an obstructive nephropathy due to tubular casts. Immunoperoxidase and immunofluorescence studies demonstrated the presence of heterogeneous light chains within these casts. This unique drug-induced renal disease is discussed with reference to the literature and to possible analogies with myeloma kidney.

Light chain effects on alanine and glucose uptake by renal brush border membranes

Effect of varying concentrations (0 to 800 microM) of three different light chains on sodium-dependent L-(14C)alanine and D-(14C)glucose uptake by rat renal brush border membrane vesicles were studied. One kappa and two lambda type light chains (lambda-1 and lambda-2) were isolated from urines of patients with multiple myeloma. At maximal inhibitory concentrations the kappa chain reduced alanine uptake from 206 +/- 18 to 77 +/- 18 pmole/mg protein (P less than 0.005) and glucose uptake from 357 +/- 22 to 146 +/- 8 pmole/mg protein (P less than 0.001). lambda-1 reduced alanine uptake from 136 +/- 17 to 60 +/- 8 pmole/mg protein (P less than 0.005) and glucose uptake from 354 +/- 17 to 77 +/- 14 pmole/mg protein (P less than 0.001). lambda-2 reduced alanine uptake from 105 +/- 9 to 28 +/- 5 pmole/mg protein (P less than 0.001) and glucose uptake from 194 +/- 7 to 66 +/- 7 pmole/mg protein (P less than 0.001). The half maximal inhibitory concentrations (I50) of kappa, lambda-1 and lambda-2 light chains were 68, 76 and 140 microM for alanine uptake and 120, 70 and 105 microM for glucose uptake. Control experiments using bovine serum albumin and beta-lactoglobulin showed no inhibitory effect on alanine and glucose uptake by either protein. These data reveal brush border membrane effects by myeloma light chains and confirm that direct Bence Jones protein nephrotoxicity may play an important role in the pathogenesis of kidney dysfunction associated with multiple myeloma.

Fingerprint-like straight crystalloid microfilaments in lobular glomerulonephritis

This 64-year-old male presented edema and proteinuria. With increasing renal insufficiency and persistent fever, he died 7 months after the onset of illness, complicated with terminal miliary tuberculosis. All the glomeruli showed sclerotic nodular lobulation and mesangial circumferential interposition with positive immunoglobulin and complement predominantly along the capillary, consistent with lobular glomerulonephritis (LGN) or terminal stage of membranoproliferative glomerulonephritis (MPGN). Electron microscopy revealed subepithelial straight crystalloid microfilaments in the amorphous deposits. These structures possibly represent IgG or its fragment as a component of immune complex crystallized in some particular condition.

Acute renal failure in patients with multiple myeloma

In the past, patients with multiple myeloma and acute renal failure have had a poor prognosis. Few patients recovered renal function and fewer still survived for prolonged time periods. This report describes the course of 10 patients with multiple myeloma and true acute renal failure treated during the decade 1970 to 1980, and reviews recent reports concerning this association. The use of radiographic contrast agents is no longer the primary predisposing factor to acute renal failure in the myeloma population. Rather, infection, hypercalcemia, and dehydration in the presence of light chain excretion are the major conditions precipitating the renal failure. Despite severe renal failure requiring dialysis, many patients may regain good renal function. Factors associated with a good or poor prognosis in this population are reviewed. The prognosis in patients with myeloma and acute renal failure has greatly improved in recent years, and prolonged survival may occur.