Abstract: FR-PO0478
Light-Chain Cast Nephropathy Revealing Multiple Myeloma in a Young Patient: Diagnostic Value of Kidney Biopsy
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Sokwala, Ahmed Parwizali, The Aga Khan University Hospital Nairobi, Nairobi, Nairobi County, Kenya
- Mirera, Cornelius Mariita, The Aga Khan University Hospital Nairobi, Nairobi, Nairobi County, Kenya
Introduction
Renal impairment is a frequent and clinically significant complication of multiple myeloma (MM), most commonly due to light chain cast nephropathy (LCCN). However, diagnosis may be delayed in patients presenting with non-specific symptoms and without classical features of plasma cell dyscrasia.
Case Description
41-year-old woman with no comorbidities who presented with an 8-month history of progressive, non-specific chest pain, followed by oliguria and lower limb edema. Laboratory evaluation revealed pancytopenia, metabolic acidosis, and severe renal impairment. Serum studies demonstrated a monoclonal gammopathy with elevated lambda free light chains and a suppressed kappa/lambda ratio (0.10). Urinalysis had mild proteinuria without casts. Renal biopsy revealed extensive tubular injury with intraluminal eosinophilic casts demonstrating lambda light chain restriction, consistent with LCCN. Subsequent bone marrow biopsy confirmed MM with >90% plasma cell infiltration. The patient required hemodialysis and was put on bortezomib-based chemotherapy.
Discussion
This case highlights an atypical presentation of multiple myeloma in a young patient, with delayed diagnosis due to non-specific symptoms and absence of classical CRAB features. The patient initially presented with prolonged chest pain repeatedly treated as an infectious process before developing oliguria and edema, which prompted further evaluation and revealed severe renal dysfunction and hematologic abnormalities. A unique feature was biopsy-proven light chain cast nephropathy despite absence of urinary casts and only modest proteinuria, underscoring the limited sensitivity of routine urinalysis in detecting light chain–mediated renal injury. Renal biopsy was pivotal in establishing the diagnosis and guiding treatment. The case demonstrates how delayed recognition of monoclonal gammopathy may result in severe AKI requiring dialysis and emphasizes the importance of considering multiple myeloma in unexplained AKI, even without classical features.
Acknowledgment
We thank the patient for providing consent for publication of this case report. We acknowledge hematology, pathology teams who contributed to patient care.