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Case Reports
. 2021 Jan 22;19(1):24.
doi: 10.1186/s12957-021-02135-3.

C3 glomerulonephritis along with light chain proximal tubulopathy without crystal deposits in multiple myeloma: a case report

Junhui Xu #  1 , Xiaojuan Yu #  2 , Suxia Wang #  3 , Miao Yan  1 , Mangju Wang  1 , Jinping Ou  1 , Lihong Wang  1 , Huihui Liu  1 , Xinan Cen  4
Affiliations
Case Reports

C3 glomerulonephritis along with light chain proximal tubulopathy without crystal deposits in multiple myeloma: a case report

Junhui Xu et al. World J Surg Oncol. .

Abstract

Background: Multiple myeloma causes different types of renal injury. C3 glomerulonephritis (C3GN) is characterised by an abnormal deposition of complement C3 in the glomeruli due to abnormal activation of the alternative pathway of the complement system. While the association between C3GN and multiple myeloma has been well established, mild renal injury by C3GN in multiple myeloma patients with high levels of light chain has not been reported.

Case presentation: A 55-year-old Chinese man presented with proteinuria. Combined with immunofixation electrophoresis, bone marrow biopsy, and renal biopsy, he was diagnosed with IgA-type multiple myeloma accompanied by C3GN and light chain proximal tubulopathy without crystal deposits. Although he had a higher level of lambda serum-free light chain, the renal injury in this patient was mild. After treatment with four courses of BD, one course of PAD, and autologous stem cell transplantation, he achieved a very good partial hematologic response with stable renal function.

Conclusions: In multiple myeloma, the light chain reaches a certain level and persists, resulting in C3GN renal impairment. Early diagnosis and early intensive treatment are critical for the prognosis of such patients.

Keywords: Autologous stem cell transplantation; C3 glomerulonephritis; Light Chain proximal tubulopathy without crystal deposits; Multiple myeloma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The patient’s renal pathology report showing a granular C3 deposition mostly in the mesangial area on the frozen section (× 200), b κ light chain negativity in the glomeruli and tubular epithelial cells on the frozen section (× 200), c stronger background staining for λ light chain than κ (yellow arrow) and massive λ reabsorption granules in the cytoplasm of tubular epithelial cells (red arrow) on the frozen section (× 200), d moderate mesangial proliferation (black arrow) (× 400, PASM+Masson), e mesangial electron-dense deposition (red arrow, × 8000), and f abnormal lysosomes in the cytoplasm of proximal tubular epithelial cells (red arrow, × 15,000)
Fig. 2
Fig. 2
The timeline of kidney function, 24 h UTP, C3, serum-free lambda light chain, and urine lambda light chain levels relative to treatment. BD, bortezomib plus dexamethasone; CTX, cyclophosphamide; PAD, bortezomib plus doxorubicin and dexamethasone; autoHCT, autologous stem cell transplantation
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