Crystalline Light Chain Casts and Hypercalcemia Induced Acute Kidney Injury: A Rare Presentation of Multiple Myeloma

The most common cause of acute kidney injury (AKI) in multiple myeloma is light-chain cast nephropathy (LCCN), which consists of a light chain and Tamm-Horsfall protein (THP). We herein report a 46-year-old woman with hypercalcemia and AKI. A renal biopsy showed crystalline casts, which were consist...

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Bibliographic Details
Published in:Internal Medicine 2024/06/15, Vol.63(12), pp.1751-1755
Main Authors: Nishigaito, Toshiya, Mitsumoto, Kensuke, Katsunuma, Rinko, Hirai, Yuri, Yamashita, Chikako, Mizumoto, Aya, Uzu, Takashi
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - etiology
Biopsy
Bortezomib
Bortezomib - therapeutic use
Calcium (blood)
cast nephropathy
crystalline cast
Crystallization
Female
Humans
Hypercalcemia
Hypercalcemia - blood
Hypercalcemia - diagnosis
Hypercalcemia - etiology
Immunoglobulin Light Chains - blood
Kidneys
Light chains
Middle Aged
Multiple myeloma
Multiple Myeloma - complications
Multiple Myeloma - diagnosis
Nephropathy
Tamm-Horsfall protein
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Summary:The most common cause of acute kidney injury (AKI) in multiple myeloma is light-chain cast nephropathy (LCCN), which consists of a light chain and Tamm-Horsfall protein (THP). We herein report a 46-year-old woman with hypercalcemia and AKI. A renal biopsy showed crystalline casts, which were consistent with lambda light chains but not THP. Hydration therapy and treatment to lower her serum calcium concentration were initiated immediately. She subsequently received bortezomib-based anti-myeloma therapy and recovered successfully. This was a rare case of LCCN, suggesting that hypercalcemia may play a role in the development of crystalline LCCN.
ISSN:0918-2918
1349-7235
1349-7235
DOI:10.2169/internalmedicine.2603-23