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Case Reports
. 2020 Sep 11;10(3):95-103.
doi: 10.1159/000508785. eCollection 2020 Sep-Dec.

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

Zi Yun Chang  1 , Thomas Paulraj Thamboo  2 , Clarice Shi Hui Choong  3 , Weng Kin Wong  1 , Clara Lee Ying Ngoh  1
Affiliations
Case Reports

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

Zi Yun Chang et al. Case Rep Nephrol Dial. .

Abstract

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.

Keywords: Amyloidosis; Immunoglobulin deposition disease; Myeloma.

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Conflict of interest statement

The manuscript has not been published previously in whole or part. The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
In the glomeruli, there was diffuse mesangial widening due to deposition of an amorphous substance, which stained weakly with periodic acid-Schiff stain (a). One glomerulus contained a cellular crescent (b). PAS stain, original magnification ×40.
Fig. 2
Fig. 2
The deposits in the blood vessel walls and glomeruli exhibited diffuse congophilia. However, while the stained deposits in the blood vessel walls showed strong apple-green birefringence under polarised light, this phenomenon was only seen weakly and focally in the glomerular deposits (a). On electron microscopy, the glomerular deposits were composed of randomly arranged fibrils with a mean diameter of 8 nm (b). Original magnification ×135,000.
Fig. 3
Fig. 3
Proposed clinicopathological algorithm for suspected monoclonal immunoglobulin (MIg)-associated renal disease.
See this image and copyright information in PMC

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