Multiple Myeloma-Associated Light Chain Amyloidosis and a Proposed Approach to Monoclonal Immunoglobulin-Associated Renal Disease

Many challenges remain in diagnosing monoclonal immunoglobulin-associated renal disease, despite widespread application of immunofluorescence (IF) and immunohistochemistry. Here, we report a newly diagnosed case of multiple myeloma with clinical suspicion of renal amyloidosis, which had negative IF...

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Bibliographic Details
Published in:Case reports in nephrology and dialysis 2020-09, Vol.10 (3), p.95-103
Main Authors: Chang, Zi Yun, Thamboo, Thomas Paulraj, Choong, Clarice Shi Hui, Wong, Weng Kin, Ngoh, Clara Lee Ying
Format: Article
Language:English
Subjects:
Amyloidosis
Biopsy
Blood vessels
Bone marrow
Case Report
Case reports
Chemotherapy
Creatinine
Family medical history
immunoglobulin deposition disease
Immunoglobulins
Kidney diseases
Laboratories
Light
Microscopy
Multiple myeloma
myeloma
Proteins
Scientific imaging
Stains & staining
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Description
Summary:Many challenges remain in diagnosing monoclonal immunoglobulin-associated renal disease, despite widespread application of immunofluorescence (IF) and immunohistochemistry. Here, we report a newly diagnosed case of multiple myeloma with clinical suspicion of renal amyloidosis, which had negative IF staining for kappa and lambda light chains in the glomeruli. Although laser microdissection and mass spectrometry-based proteomic analysis have emerged as important tools for amyloid typing in the literature, such facilities are still not widely available in Asia. We propose that a clinicopathological algorithm for the evaluation of organized monoclonal renal deposits, together with a combined nephrological-haematological approach, will still be adequate to generate an unequivocal diagnosis in the majority of cases.
ISSN:2296-9705
2296-9705
DOI:10.1159/000508785