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Case Reports
. 2015 Sep 2;5(3):180-6.
doi: 10.1159/000439267. eCollection 2015 Sep-Dec.

Progression of Monoclonal Gammopathy with Undetermined Significance to Multiple Myeloma Diagnosed by Kidney Biopsy: A Case Report

Jin Hae Kim  1 , Ji Won Kim  1 , Young Nam Kim  1 , Hye In Kim  1 , Jun Young Kim  1 , Ghee Young Kwon  2 , Kihyun Kim  3 , Hye Ryoun Jang  4
Affiliations
Case Reports

Progression of Monoclonal Gammopathy with Undetermined Significance to Multiple Myeloma Diagnosed by Kidney Biopsy: A Case Report

Jin Hae Kim et al. Case Rep Nephrol Dial. .

Abstract

Monoclonal gammopathy with undetermined significance (MGUS) carries a risk of progression to multiple myeloma, and progression is usually diagnosed with changes in M-protein or bone marrow biopsy. We report a case of 62-year-old female patient showing MGUS progression to multiple myeloma without significant changes in M-protein but diagnosed by kidney biopsy. During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein. Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia. The progression of MGUS to multiple myeloma was diagnosed by this kidney biopsy. The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

Keywords: Monoclonal gammopathy of undetermined significance; Multiple myeloma; Proteinuria.

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Figures

Fig. 1
Fig. 1
Features of the second kidney biopsy. a Under light microscopy, tubular epithelial cells contained vacuolated cytoplasm (arrows) accompanied by minimal interstitial fibrosis and mild mononuclear infiltration. Periodic acid-Schiff stain. ×400. b–d Electron microscopy revealed electron-dense intracytoplasmic inclusions in the epithelial cells of some tubules as well as in the urinary space and the podocytes of some glomeruli (black and white arrows). These inclusions were variable in size and ovoid to angular in shape. Original magnifications, ×6,000, ×3,000, and ×7,000, respectively. e Immunofluorescent staining for κ is negative in glomeruli. ×200. f Immunofluorescent staining for λ is negative in glomeruli. ×200.
Fig. 2
Fig. 2
Clinical course from MGUS to multiple myeloma before and after chemotherapy. a The second kidney biopsy was performed when both azotemia and proteinuria were aggravated without elevation of serum M-protein. After 8 cycles of chemotherapy, serum creatinine levels decreased significantly. b Spot urine protein-to-creatinine levels were also reduced by chemotherapy. c–e Serum M-protein levels and the κ/λ FLC ratio as well as serum κ FLC concentration were normalized after chemotherapy.
See this image and copyright information in PMC

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