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Abstract: SA-PO142

AKI due to Light Chain Cast Nephropathy in Non-IgM Lymphoplasmacytic Lymphoma

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Rodziewicz, Natalie, University Hospitals, Cleveland, Ohio, United States
  • Kapp, Meghan, University Hospitals, Cleveland, Ohio, United States
  • Rashidi, Arash, University Hospitals, Cleveland, Ohio, United States
Introduction

Plasma cell dyscrasia most notably multiple myeloma known to cause cast nephropathy, we report a case of non- IgM lymphoplasmacytic lymphoma causing an acute kidney injury due to lambda light chain cast nephropathy.

Case Description

74-year-old white male with history of chronic kidney disease stage III, heart failure with reduced ejection fraction of 35%, hypertension, diabetes type II, presented to hospital with chief complaint of 2 days of left lower quadrant abdominal pain. Non-contrast CT scan imaging reported acute diverticulitis, and patient was started on IV antibiotics with Zosyn. Symptoms promptly subsided the following day. Patient was noted to have acute kidney injury on presentation. Laboratory data showed initial serum creatinine (SCr) 2.03 mg/dL, blood urea nitrogen (BUN) 53 m/dL, by day three of hospitalization patient had developed anuria and SCr increase to 4.13 mg/dl and day nine SCr, further increase to 11 mg/dl. Serum protein electrophoreses and free light chains analysis revealed IgG Lambda M-protein 1.7g/dl, Kappa light chain 15.4 mg/dl, Lambda light chain 150.3 mg/dl, with a K/L ratio 0.1. Patient was advised to have bone marrow biopsy due to high concern for plasma cell dyscrasia, which revealed non- IgM lymphoplasmacytic lymphoma. PET scan revealed mild diffuse bone marrow uptake, with no avid lymph node or spleen uptake. Renal biopsy showed atypical granular casts that stain for only lambda, suggestive of early light chain cast nephropathy. Patient was started on hemodialysis due to concerns for uremic encephalopathy and volume overload, with no sign of renal recovery. The following week hematology team initiated patient on chemotherapy with bendamustine and rituximab.

Discussion

Lymphoplasmacytic lymphoma is very rare diagnosis that does not commonly produce monoclonal immunoglobulins. It is likely that this malignancy was underlying for some time due to indolent course of the lymphoma, and the acute kidney failure due to light chain cast nephropathy was precipitated by the acute diverticulitis, possible due to volume depletion and NSAID use.