Kidney Week

Abstract: PUB012

A Case of AL Amyloidosis and Nephrotic Syndrome Complicated by Renal Vein Thrombosis

Session Information

• Publication Only

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Gu, Mingyu, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Mingyu Gu, APRN, DNP, RN

• Drury, Zachary, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Zachary Drury, APRN, CCRN, CNN-NP, DNP, NP, RN

• Hartsell, Sydney Elizabeth, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Sydney Elizabeth Hartsell, MD, MPH

• Al-Rabadi, Laith, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Laith Al-Rabadi, MD

• Gilligan, Sarah, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Sarah Gilligan, MD, MS

• Cho, Monique E., Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, United States

Monique E. Cho, MD

Introduction

Renal vein thrombosis (RVT) is most classically associated with membranous nephropathy and is considered an unusual complication of AL amyloidosis. We present a case of AL amyloidosis secondary to multiple myeloma (MM) complicated by RVT extending into the inferior vena cava (IVC).

Case Description

A 57-year-old man with AL amyloidosis and MM was treated with Dara-CyBorD but experienced disease progression. His course was complicated by sepsis and AKI, with serum creatinine increasing from 1.3 to 2.9 mg/dL and serum albumin 1.7 g/dL. Urinalysis revealed UPCR 18.8g/g, without gross or microscopic hematuria. CT demonstrated non-occlusive left RVT extending into the IVC, deep vein thrombosis, and a large acute pulmonary embolism. He was treated with thrombectomy and anticoagulation, and ultimately required renal replacement therapy. The progression of renal failure involved both pre-renal and intrinsic causes, including infection/hypotension, progression of AL amyloidosis/multiple myeloma, renal vein thrombosis, and contrast exposure. He remains hemodialysis-dependent 3 months later.

Discussion

This case highlights the hemostatic complexity of AL amyloidosis. Though predominated by bleeding, severe nephrotic syndrome can shift the balance toward thrombosis through loss of anticoagulant or upregulation of procoagulant factors. The thrombotic burden of MM-associated hyperviscosity and bacteremia likely tipped this patient into multi-site venous thrombosis. Clinicians should maintain heightened suspicion for venous thromboembolism in patients presenting with acute kidney injury in the setting of AL amyloidosis, heavy proteinuria, and hypoalbuminemia. A low threshold for imaging to exclude RVT, as timely diagnosis and anticoagulation may improve the chance of renal recovery.

CT revealed L non-occlusive renal vein thrombosis extended into IVC.