Abstract

Acute on chronic renal failure is a common but notably broad diagnosis. We present a 64-year-old man with a history of diastolic heart failure and chronic kidney disease, admitted for an elevated creatinine. History and physical examination were suggestive of decompensated heart failure; however, the careful interpretation of urinalysis rendered the diagnosis of multiple myeloma. On renal biopsy, the patient was found to have light chain deposition disease with cast nephropathy. Combination lesions in multiple myeloma are rare and require diligent histopathology for detection, including light microscopy, immunofluorescence and electron microscopy. These patients portray different demographics, renal manifestations, oncologic characteristics and outcomes, and hence, further studies isolating these combined lesions are warranted.

Abbreviations: CKD: chronic kidney disease; CN: cast nephropathy; CT: computerized tomography; EDD: electron-dense deposits; EM: electron microscopy; IF: immunofluorescence; FLC: free light chain; LC: light chain; LCDD: light chain deposition disease; MIDD: monoclonal immunoglobulin deposition disease; MM: multiple myeloma; LM: light microscopy; NGS: nodular glomerulosclerosis; κ: kappa; λ: lambda.

Details

Title
Acute kidney injury on chronic kidney disease: from congestive heart failure to light chain deposition disease and cast nephropathy in multiple myeloma
Author
Shaikh, Sana 1   VIAFID ORCID Logo  ; Nwankwo, Christian 2 ; Lacasse, Alexandre 1 ; Cheng, Steven 3 

1  Department of Internal Medicine, SSM St. Mary’s Hospital, St. Louis, St. Louis, MO, USA 
2  Department of Nephrology, SSM St. Mary’s Hospital, St. Louis, St. Louis, MO, USA 
3  Department of Nephrology, Washington University School of Medicine, St. Louis, MO, USA 
End page
321
Publication year
2019
Publication date
Jul 2019
Publisher
Greater Baltimore Medical Center
e-ISSN
20009666
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1080/20009666.2019.1624136
ProQuest document ID
2332148596
Copyright
© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center. This work is licensed under the Creative Commons  Attribution – Non-Commercial License http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.