Abstract: TH-PO1152
Dialysis Within 11 Months: IgA Myeloma Cast Nephropathy
Session Information
- Onconephrology: Emerging Biomarkers, Preclinical Models, Clinical Challenges, and Therapeutic Strategies
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Rajashekar, Shriya, Quinnipiac University, Hamden, Connecticut, United States
- Thong, JIa Yean, Quinnipiac University, Hamden, Connecticut, United States
- Pena, Oscar, Quinnipiac University, Hamden, Connecticut, United States
- Umar, Sumayya, Quinnipiac University, Hamden, Connecticut, United States
- Bhat, Nuthan, Quinnipiac University, Hamden, Connecticut, United States
- Mahali, Rakesh Raju, Quinnipiac University, Hamden, Connecticut, United States
Introduction
IgA myeloma (20% of cases) carries higher kidney impairment risk. Cast nephropathy by free light chains and exacerbated by nephrotoxins, is the leading cause of severe AKI in myeloma. We report IgA kappa myeloma with fulminant cast nephropathy requiring dialysis, with early anti-CD38 therapy.
Case Description
A 60-year-old African American woman with hypertension presented with weakness, poor appetite, and lightheadedness. Creatinine was 0.9 mg/dL and hemoglobin 10.0 g/dL 11 months prior. She reported daily NSAID use and had self-reduced valsartan-HTZ due to BPs in the 90s/60s. Labs revealed severe anemia and AKI. Absence of uremic symptoms despite creatinine 7.5 mg/dL suggested subacute progression. Calcium was normal. Serum protein studies had abnormalities (table). MRI pelvis 1 month prior showed heterogeneous marrow with osseous lesions concerning for myeloma, unrecognized at the time. Given persistent oliguria despite hydration, hemodialysis began day 3. Marrow biopsy had 75% involvement by CD138 positive, kappa-restricted plasma cells; flow cytometry had CD38/VS38/CD56 expression, negative for amyloid. Kidney biopsy had cast nephropathy. The patient met criteria; CyBorD was initiated. She was discharged on thrice-weekly hemodialysis. Despite hematologic response, renal recovery has not been achieved, on cycle 4 of CyBorD with weekly dexamethasone, no regimen adjustments required, and is due for transplant evaluation.
Discussion
This case illustrates the aggressive biology of IgA myeloma, with progression from normal renal function to dialysis dependence in 11 months driven by kappa light chain overproduction (1,400 mg/L). Concomitant NSAIDs, RAAS blockade, and hypovolemia compounded the nephrotoxic milieu, accelerating cast nephropathy. Renal biopsy was essential, as over 15% of myeloma associated AKI has unrelated etiologies. Bortezomib-based regimens achieve 72% renal response rates, with 59% of dialysis-dependent patients regaining independence (median OS 98.3 months, 2-year OS 84%), reinforcing the importance of rapid light chain reduction.