Kappa Light Chain Myeloma Presenting as Acute Renal Failure
- Geriatric Nephrology
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
- Menon, Lakshmi, NewYork Presbyterian - Brooklyn Methodist Hospital, Brooklyn, New York, United States
- Neelakantappa, Kotresha H., NewYork Presbyterian - Brooklyn Methodist Hospital, Brooklyn, New York, United States
Multiple Myeloma is a plasma cell dyscrasia commonly affecting the elderly. Acute renal failure carries a particularly poor prognosis. Here we present a 95-year-old woman who came with fatigue, polyuria and new onset renal failure. Work up showed multiple myeloma with kidney biopsy showing diffuse tubular necrosis and bone marrow biopsy showing kappa light chain myeloma. She was started on chemotherapy within 13 days of admission. Despite prompt initiation of chemotherapy, kidney function did not improve, and she deteriorated in a month’s time.
The patient was a 95-year-old woman with a history of HTN/HLD and a remote history of PE on warfarin. She was fully functional and independent at baseline; she was compliant with medication and labs 6 months prior were normal. She was referred to the ED for bradycardia, had been having polyuria and fatigue one week prior. In the ED, vitals were normal, physical exam showed chronic bilateral hearing loss, labs were notable for a Hgb of 6.5, MCV of 104, a BUN of 150 and a Cr of 12 with a potassium of >7.5, her corrected calcium was 9.5; a stool occult test was positive, and her INR was 7.9. She was admitted to the ICU for CVVHD, concern for acute GI bleed with severe pre-renal AKI, however her hemoglobin normalized and was unable to wean off HD. Workup for RPGN, vasculitis and multiple myeloma was done which showed significantly elevated kappa/lambda ratio, kidney biopsy showed diffuse acute tubular necrosis without glomerulonephritis and bone marrow biopsy and serum studies showed kappa light chain myeloma. Chemotherapy was started 13 days after diagnosis; however, her kidney function did not improve, and she deteriorated within a month from episodes of fluid overload while on dialysis and vascular access site infections.
Renal impairment in multiple myeloma has a life expenctancy of less than a year, and is an independent negative prognostic factor when noted in the first 6 months of diagnosis. The biggest indicator of overall prognosis is renal response to treatment including dialysis and chemotherapy. Our patient’s case showed a rare case of kappa light chain myeloma presenting with acute renal failure from ATN which unfortunately did not improve with treatment. More research into modalities such as high output dialysis or plasmapheresis in this population would be useful to reduce light chain burden and resulting ATN.