Multiple Myeloma as a rare cause of membranoproliferative glomerular nephritis

S Sivansuthan,Albert Nimalan

doi:10.4038/jmj.v33i2.140

Abstract

Multiple myeloma (MM) is a relatively uncommon cancer characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin(Ig). Renal failure in multiple myeloma is around 48% and it may be the presenting manifestation of MM.[1] Renal involvement is multifactorial including light chain cast nephropathy amyloidosis, monoclonal Ig deposition disease and less frequently cryoglobulinaemic glomerulonephritis and proliferative glomerulonephritis.[2-5] Hence membrano proliferative glomerulonephritis (MPGN) is a rare form in MM. Here we report a case of multiple myeloma with MPGN in a 60-year-old male who succumbed to death while on chemotherapy.

Highlights

Multiple myeloma accounts for 17 % of all haematological malignancies, and its incidence increases with age.[6]
The international Myeloma Working group criteria for the diagnosis of MM emphasize the importance of end-organ damage in making the diagnosis the diagnosis of MM requires Clonal bone marrow plasma cells >=10% or biopsy proven bony or soft tissue plasmacytoma plus one of the following
Presence of related organ or tissue impairment

Summary

Introduction

Multiple myeloma accounts for 17 % of all haematological malignancies, and its incidence increases with age.[6] One important organ that commonly gets affected is kidney and the three most common forms of monoclonal Ig-mediated kidney diseases are light chain cast nephropathy, monoclonal Ig deposition disease (MIDD), and AL amyloidosis.[2,3,4] Beyond these three forms, Glomerular nephritis with active urinary sediment such as membranoproliferative and cryoglobulinaemic glomerular nephritis are reported in literature (4-5). MPGN has been classified as type I, II and III based on the microscopic appearances. Type I shows discrete immune deposits in mesangium and sub endothelium, Type II shows continuous dense ribbon like deposits along the basement membrane, tubules and Bowman’s capsule, Type III shows similar features like type I in addition to that there are sub epithelial deposits. Multiple myeloma with renal impairment should be considered as a treatable medical emergency since the recovery of renal function is associated with survival benefit

Case report

Findings

Discussion