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The multiple myeloma it´s a clonal proliferation of plasma cells and subsequent overproduction of Igs and free light chains.
Renal dysfunction is secondary manifestation of plasma cell dyscrasias. A broad range of kidney pathologies can occur, including light chain cast nephropathy, monoclonal Ig deposition disease, light chain amyloidosis, light chain proximal tubulopathy, and tubulointerstitial nephritis.
The diagnosis of LCPT is of great clinical importance; sometimes it´s not even neccesary to realize a kidney biopsy as the first step.
And the diagnosis of LCPT it´s principally by Hematology.
A 59-year-old male patient from El Salto, Durango, México; heavy machinery operator, with a history of smoking and alcohol use. History of arterial hypertension and an episode of upper gastrointestinal bleeding associated with prednisone consumption.
At the beginning of 2025, he developed clinical signs of nephrotic syndrome and renal function deterioration, with a baseline creatinine of 1.01 and a peak elevation of 5.7.
He sought evaluation and was referred to a tertiary care center, where the first kidney biopsy was performed, yielding an inconclusive report of a probable Membranous nephropaty.
In August 2025, he returned for evaluation, reporting persistent lower back pain. The diagnostic approach was resumed, showing a creatinine of 3.7, urea 200, hemoglobin 10.4, viral panel, ANA, ANCA, and anti-DNA negative, IgG 3625, and 18.7 g of protein in a 24-hour urine collection. We suggested a second biopsy to determinate the etiology, so renal replacement therapy in the form of hemodialysis was initiated due to high bleeding risk.Plasma cell dyscrasias such as multiple myeloma (MM) result from clonal proliferation of plasma cells and subsequent overproduction of Igs, including free light chains. Renal dysfunction is a core manifestation of plasma cell dyscrasias. A broad range of kidney pathologies can occur, including light chain cast nephropathy, monoclonal Ig deposition disease, light chain amyloidosis, light chain proximal tubulopathy, and tubulointerstitial nephritis.
The second biopsy was performed in which 20 glomeruli were analyzed with the following report: active tubulointerstitial nephritis with eosinophils and intratubular casts, tubular microcalcifications, and by immunofluorescence, Lambda positive in 3 intratubular casts.
Hematology evaluation was requested, and bone marrow aspiration biopsy was performed, compatible with IgG Lambda multiple myeloma, for which chemotherapy treatment was started. Currently, renal function has not recovered, with scheduled hemodialysis sessions, probable gastrointestinal infiltration, and hypercalcemia.
The diagnosis of multiple myeloma is usually made by Hematology; however, in this case, the condition presented primarily with renal involvement, which led us to perform a second biopsy where the presence of light chains was detected, allowing us to integrate the specialized diagnosis and treatment for the patient.
