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Acute renal failure with lambda light chain-derived crystals in a patient with IgD myeloma

Cécile Toly-Ndour 1, 2 Julie Peltier 3 Remi Piedagnel 2, 4 Paul Coppo 5, 1 Emmanuelle Sachon 6 Pierre Ronco 2, 4, 7 Eric Rondeau 2, 7, 3 Patrice Callard 8 Pierre Aucouturier 1, 2, *
* Corresponding author
1 CR Saint-Antoine - Centre de Recherche Saint-Antoine
2 UPMC - Université Pierre et Marie Curie - Paris 6
3 Urgences néphrologiques et transplantation rénale [CHU Tenon]
4 Remodelage et Reparation du Tissu Renal
5 Service d'hématologie clinique et de thérapie cellulaire [CHU Saint-Antoine]
6 Plateform of Mass Spectrometry [UPMC, Paris]
7 Service de Néphrologie et Dialyses [CHU Tenon]
8 Service d’Anatomie et cytologie pathologiques [CHU Tenon]
Abstract : Kidney involvement with immunoglobulin crystals usually relates to a light chain of the kappa type, in MGUS or smoldering myeloma, frequently causing Fanconi's syndrome with progressive renal insufficiency. We report on a case with severe myeloma featuring lambda light chain-derived crystals and acute kidney injury. Histology showed acute tubular necrosis and tubule obstruction with crystals, which were also abundant inside tubule epithelial cells, macrophages and bone marrow plasma cells. The light chain variable domain had a normal overall primary structure but included 11 somatic mutations, 3 of which likely increased the surface hydrophobicity, as observed in previously reported kappa-type crystals.
Keywords : myeloma immunoglobulin light chain acute kidney injury crystals
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INSERM | U938 | UPMC | SORBONNE-UNIVERSITE | SU-MEDECINE | SU-TI

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Cécile Toly-Ndour, Julie Peltier, Remi Piedagnel, Paul Coppo, Emmanuelle Sachon, et al.. Acute renal failure with lambda light chain-derived crystals in a patient with IgD myeloma. Nephrology Dialysis Transplantation, Oxford University Press (OUP), 2011, 26 (9), pp.3057 - 3059. ⟨10.1093/ndt/gfr377⟩. ⟨inserm-01931323⟩

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