Crystalline Light Chain Casts and Hypercalcemia Induced Acute Kidney Injury: A Rare Presentation of Multiple Myeloma

Toshiya Nishigaito; Kensuke Mitsumoto; Rinko Katsunuma; Yuri Hirai; Chikako Yamashita; Aya Mizumoto; Takashi Uzu

doi:10.2169/internalmedicine.2603-23

This article has now been updated. Please use the final version.

Crystalline Light Chain Casts and Hypercalcemia Induced Acute Kidney Injury: A Rare Presentation of Multiple Myeloma

Toshiya Nishigaito, Kensuke Mitsumoto, Rinko Katsunuma, Yuri Hirai, Chikako Yamashita, Aya Mizumoto, Takashi Uzu

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Keywords: multiple myeloma, cast nephropathy, crystalline cast, Tamm-Horsfall protein, hypercalcemia

JOURNAL OPEN ACCESS Advance online publication

Article ID: 2603-23

DOI https://doi.org/10.2169/internalmedicine.2603-23

The final version of this article is now available: Vol. 63 (2024), No. 12 pp. 1751-1755

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Abstract

The most common cause of acute kidney injury (AKI) in multiple myeloma is light-chain cast nephropathy (LCCN), which consists of a light chain and Tamm-Horsfall protein (THP). We herein report a 46-year-old woman with hypercalcemia and AKI. A renal biopsy showed crystalline casts, which were consistent with lambda light chains but not THP. Hydration therapy and treatment to lower her serum calcium concentration were initiated immediately. She subsequently received bortezomib-based anti-myeloma therapy and recovered successfully. This was a rare case of LCCN, suggesting that hypercalcemia may play a role in the development of crystalline LCCN.

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