Rapid renal failure in a case of multiple myeloma: the role of Bence Jones proteins

Abstract

The rapid onset of subacute renal failure in a patient without prior known kidney disease prompted the present study. A renal biopsy specimen showed the characteristic pathological changes of `myeloma kidney', including deposition of proteinaceous material in the lumen of the proximal tubules. Cellulose-acetate electrophoresis of the patient's serum failed to indicate any protein abnormalities, although Bence Jones proteinaemia was readily demonstrated by agar-gel electophoresis.

In immunofluorescence studies of kidney tissue obtained post mortem, the region of the tubular basement membrane reacted positively with anti-kappa antiserum and with antiserum to Bence Jones protein isolated from the patient's serum. The material occluding the tubular lumens, however, failed to stain with either antiserum. The occurrence of acute or subacute renal failure in patients with multiple myeloma has been attributed to occlusion of the renal tubules by deposits of Bence Jones proteins. The data obtained in this study indicate the need for re-examining this concept.