Myeloma Cast Nephropathy
Feature
Disease Facts
Synonyms
Myeloma kidney.
Epidemiology Common in patients with plasma cell dyscrasias.
Etiology
and
Pathogenesis
Deposition of monoclonal immunoglobulins or Ig light chains in glomeruli or tubulointerstitium.
Clinical
Presentation
Proteinuria, nephrotic syndrome, or renal insufficiency.
Laboratory
Features
Proteinuria, increased renal size, abnormal serum and/or urine protein electrophoresis.
Anatomic
Pathology
LM - Ig deposits, may be nodular. Light chains may deposit as amyloid or precipitate as “hard” casts. Membranous or proliferative pattern possible. Cryoglobulins produce microthrombi. IgM deposits in Waldenstrom's macroglobulinemia.
IF - Autofluorescence. + kappa or lambda stain.
EM - Amyloid may be identified.
Clinical
Course
Progressive renal failure with ESRD in 2nd or 3rd decades.
Treatment
No specific treatment. Chemotherapy may slow progression of disease.
References
and
Web Links
Web Links - General Information

U.S. Army http://www.wramc.amedd.army.mil/departments/medicine/Nephro/Nephrology/lectures/myeloma/index.htm
Int. Myeloma
Foundation
http://www.myeloma.org/imf_mmc.html

Web Links - Images

UPMC http://www.omed.pitt.edu/MS-II/BODY-FLUID/RENAL/LAB/CASE15/index.html
NKF http://www.ajkdjournal.org/atlas/32/4/atlas32_4.htm