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Kidney Week

Abstract: FR-PO695

A Case of Concurrent Multiple Myeloma and LECT2 Amyloidosis

Session Information

Category: Trainee Case Report

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Ekenna, Chidinma, Baylor College of Medicine, Houston, Texas, United States
  • Santa cruz, John R., Baylor College of Medicine, Houston, Texas, United States
  • Dolson, George M., Baylor College of Medicine, Houston, Texas, United States
  • Dave, Natasha Naresh, Baylor College of Medicine, Houston, Texas, United States
Introduction

Multiple myeloma is a cancer of plasma cells that can lead to kidney problems. Leukocyte chemotactic factor 2 amyloidosis (ALECT2) is one of the most recently described forms of amyloid with unknown etiology, strong ethnic predominance and manifests as slow progressive renal failure.

Case Description

44-year-old Hispanic female with no prior past medical history, presented to the ER with headache, nausea, fatigue and RLE pruritic rash x2 months and lab values concerning for acute kidney failure. Symptoms worsened 2 weeks prior to presentation with persistent headaches, emesis, hypersomnia and dyspnea on exertion. Physical exam with mild diffuse abdominal tenderness and dry RLE rash. Initial labs with BUN 58 mg/dL & Cr 5.40 mg/dL (1.1 mg/dL 5 months prior). Urine studies revealed UA with 1+ protein, protein/Cr ratio 4.52 g; CBC remarkable for anemia and thrombocytosis. Abdominal ultrasound unremarkable except moderate hepatomegaly. Work-up remarkable for positive ANA, SPEP with kappa light chain monoclonal peak in gamma region and abnormal serum & urine K/L ratio. Renal biopsy showed amyloidosis with positive congo red stain for amyloid deposits suspicious for LECT2 Amyloid and focal atypical kappa light chain dominant casts; 30% IFTA. Skeletal survey with multiple skull lytic lesions. Bone marrow biopsy and staining consistent with IgG Kappa multiple myeloma. Patient started on Velcade/Dex for IgG kappa multiple myeloma. Discharged with outpatient follow up

Discussion

Renal LECT2 amyloidosis is an uncommon form of amyloidosis of unknown etiology that causes slowly progressive renal failure with affinity to kidney and liver and more commonly seen in Hispanic patients. No available treatment except renal transplantation once end stage kidney disease is established.
There are different types of myeloma, classified by the type of immunoglobulin produced by the abnormal plasma cells. IgG kappa type is the most common abnormal M protein.
There has been overlap between multiple myeloma and amyloidosis with patients frequently diagnosed with both myeloma and AL amyloidosis, which is not the case in our patient with multiple myeloma and LECT2 amyloid. Thus, thorough categorization of patients presenting with renal amyloidosis should be encouraged to broaden the understanding of these subtypes and afford appropriate therapy and accurate prognosis to avoid unnecessary treatment.