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Wang D, Wang Y, Sun S. Renal pathological changes after successful treatment of LCDD using cyclophosphamide, thalidomide, and dexamethasone. Ren Fail 2021; 43:1425-1427. [PMID: 34657562 PMCID: PMC8526028 DOI: 10.1080/0886022x.2021.1988967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Di Wang
- Department of Nephrology, Xijing Hospital, the First Affiliated Hospital of Fourth Military Medical University, Xi'an, China
| | - Yan Wang
- Department of Nephrology, Xijing Hospital, the First Affiliated Hospital of Fourth Military Medical University, Xi'an, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, the First Affiliated Hospital of Fourth Military Medical University, Xi'an, China
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Shimamura Y, Ogawa Y, Takizawa H, Hayashi T, Sakurai Y. Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy. Cureus 2021; 13:e15102. [PMID: 34159010 PMCID: PMC8212893 DOI: 10.7759/cureus.15102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Light chain deposition disease (LCDD) is characterized by the deposition of monoclonal immunoglobulin light chains in the kidney, which can cause end-stage kidney disease if not treated. While kidney biopsy is required for definitive diagnosis, choosing an appropriate biopsy method may be problematic when examining patients with atrophic kidneys. A 66-year-old Japanese man was referred to our institution with a three-month history of leg edema. Clinical investigations revealed proteinuria levels of 7.5 g/day. CT-guided percutaneous kidney biopsy was selected as the biopsy method because atrophic kidneys were poorly visualized on ultrasonography. Kidney biopsy revealed nodular glomerulosclerosis, exclusive deposition of the κ chain, and powdery electron-dense deposits, all of which were indicative of LCDD. Bence-Jones protein was detected in the urine. The patient also had an abnormal serum-free light chain ratio. Bone marrow biopsy revealed multiple myeloma; therefore, the patient was diagnosed to have LCDD with multiple myeloma. The patient was treated with daratumumab, bortezomib, cyclophosphamide, and dexamethasone. After a one-year follow-up, the patient had hematological and renal responses without any treatment-related adverse effects. Our case demonstrates the effectiveness of daratumumab as a treatment for LCDD with nephrotic-range proteinuria. Additionally, we suggest that CT-guided kidney biopsy should be considered as a diagnostic test in patients with kidney atrophy when making a definitive diagnosis.
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Affiliation(s)
| | - Yayoi Ogawa
- Department of Renal Pathology, Hokkaido Renal Pathology Center, Sapporo, JPN
| | - Hideki Takizawa
- Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, JPN
| | - Toshiaki Hayashi
- Department of Hematology, Teine Keijinkai Medical Center, Sapporo, JPN
| | - Yasuo Sakurai
- Department of Radiology, Teine Keijinkai Medical Center, Sapporo, JPN
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Tsushima T, Suzuki T, Terao T, Miura D, Narita K, Takeuchi M, Shimuzu A, Matsue K. Light chain deposition disease involving kidney and liver in a patient with IgD myeloma. BMC Nephrol 2021; 22:40. [PMID: 33485303 PMCID: PMC7824927 DOI: 10.1186/s12882-021-02246-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background IgD multiple myeloma (MM) is a rare subtype of MM and light chain deposition disease (LCDD) outside the kidney is also a rare and has scarcely been reported. We report herein the details of the first reported case of LCDD involving the kidney and liver co-occurring with IgD myeloma. Case presentation A 66-year-old female with IgD MM presented with rapidly progressive acute renal failure, ascites and pleural effusion. Immunofluorescent study of revealed the characteristic linear deposition of Igκ light chain along the glomerular and tubular basement membrane in kidney. Electron microscopy showed the powdery electron-dense deposits along the tubular and glomerular basement membrane consistent with the diagnosis of LCDD. Laser microdissection followed by mass spectrometry identified only Igκ light chain with more than 95% probability confirm the diagnosis of κ-LCDD but not heavy/light chain deposition disease. Liver biopsy with immunofluorescence study revealed the linear deposition of Igκ chain along the perisinusoidal space indicating the hepatic involvement of κ-LCDD. The patient was successfully treated with combination therapy with bortezomib, cyclophosphamide, dexamethasone, and daratumumab. Conclusions This report emphasizes that prompt biopsy of affected organs and initiation of clone directed therapy led to the correct diagnosis and favorable outcome in patient with LCDD who has extrarenal involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02246-9.
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Affiliation(s)
- Takafumi Tsushima
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Tomo Suzuki
- Division of Nephrology, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Toshiki Terao
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan
| | - Akira Shimuzu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8601, Japan.
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Ueno T, Kikuchi K, Hazue R, Mise K, Sumida K, Hayami N, Suwabe T, Hoshino J, Sawa N, Arizono K, Hara S, Takaichi K, Fujii T, Ohashi K, Ubara Y. Five Sequential Evaluations of Renal Histology in a Patient with Light Chain Deposition Disease. Intern Med 2016; 55:2993-2999. [PMID: 27746438 PMCID: PMC5109568 DOI: 10.2169/internalmedicine.55.6213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man was referred to our institution for an evaluation of nephrotic range proteinuria. Renal biopsy showed a marked expansion of the mesangial matrix and thickening of glomerular basement membrane (GBM) in periodic acid-silver methenamine (PAM). Immunofluorescence (IF) revealed strong staining for the monoclonal kappa light chain. EM demonstrated massive subendothelial and mesangial dense deposits. As a result, light chain deposition disease (LCDD) was diagnosed. Melphalan and prednisolone (MP) therapy was started, which was continued for 10 years with minimal complications. Serial evaluations of renal histology revealed the resolution of nodular lesions and the glomeruli became nearly normal. MP therapy can therefore be an effective therapeutic option for LCDD if it is continued over the long term.
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Rekhtina IG, Zakharova EV, Stolyarevich ES, Sinitsina MN, Denisova EN. [The concurrence of light-chain deposition disease, AL-amyloidosis, and cast nephropathy in a patient with multiple myeloma]. TERAPEVT ARKH 2015; 87:98-101. [PMID: 26281203 DOI: 10.17116/terarkh201587698-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite of the fact that their clinical manifestations are similar, AL-amyloidosis (AL-A) and light chain deposition disease (LCDD) are individual nosological entities in view of considerable differences in their pathogenesis and pathomorphology. The paper describes a rare case of the concurrence of LCDD and AL-A in a patient with multiple myeloma. Clinically, there was dialysis-dependent renal failure, flail leg syndrome, myocardiopathy, and rhabdomyolysis. At the disease onset, his nephrobiopsy specimen could diagnose LCDD and myeloma or cast nephropathy. The disease was characterized by an aggressive course. Despite the administration of innovative agents, the patient had a short-term remission and died from disease progression. Autopsy additionally revealed amyloid deposition in the heart and kidney. The development of AL-A in the presence of prior LCDD may reflect the progression of the tumor and the appearance of an additional subclone of plasma cells that produce amyloidogenic light chains. The uncommonness of this case is that renal amyloid was found in the tubular casts and absent in the glomeruli, which may be considered as a special form--tubular AL-amyloidosis.
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Affiliation(s)
- I G Rekhtina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E V Zakharova
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia
| | - E S Stolyarevich
- Department of Nephrology, Faculty of Postgraduate Education, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
| | - M N Sinitsina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E N Denisova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
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Rifkin SI, Weinstein SS. Late onset renal failure and nephrotic syndrome after autologous stem cell transplant for Al amyloidosis. Ren Fail 2012; 34:664-6. [PMID: 22452410 DOI: 10.3109/0886022x.2012.669320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a patient with AL amyloidosis who had an autologous stem cell transplant (ASCT) over 9 years ago. She has since then developed slowly progressive renal insufficiency and the nephrotic syndrome. Hematologic evaluation has failed to identify recurrent disease and a renal biopsy demonstrated extensive amyloid deposition and substantial glomerulosclerosis. We suggest that the patient has chronic glomerulosclerosis as a consequence of renal damage associated with her disease process and her treatment.
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Affiliation(s)
- Stephen I Rifkin
- Division of Nephrology and Hypertension, University of South Florida College of Medicine, Tampa, FL, USA.
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González-López TJ, Vázquez L, Flores T, San Miguel JF, García-Sanz R. Long-term reversibility of renal dysfunction associated to light chain deposition disease with bortezomib and dexamethasone and high dose therapy and autologous stem cell transplantation. Clin Pract 2011; 1:e95. [PMID: 24765395 PMCID: PMC3981425 DOI: 10.4081/cp.2011.e95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 12/30/2022] Open
Abstract
A 63-year-old woman presented with progressive renal insufficiency, until a glomerular filtration rate (GFR) of 12 mL/min. A renal biopsy demonstrated glomerular deposition of immunoglobulin κlight chain. The presence of a small population of monoclonal plasmacytes producing an only light κmonoclonal component was demonstrated and Bortezomib and Dexamethasone (BD) was provided as initial therapy. After seven courses of therapy, renal function improved without dialysis requirements up to a GFR 31 mL/min. Under hematological complete response (HCR) the patient underwent high dose of melphalan (HDM) and autologous peripheral blood stem cell transplant. Fifty-four months later the patient remains in HCR and the GFR has progressively improved up to 48 mL/min. This report describes a notably renal function improvement in a patient with Light Chain Deposition Disease after therapy with BD followed by HDM, which can support this treatment as a future option for these patients.
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Affiliation(s)
| | | | - Teresa Flores
- Pathology Service, University Hospital of Salamanca, Salamanca, Spain
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