Abstract: FR-PO240
Myeloma Cast Nephropathy in an HIV Patient with AKI
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Nehme, Christian, University of California Los Angeles, Los Angeles, California, United States
- Sarkar, Mrinalini, University of California Los Angeles, Los Angeles, California, United States
Introduction
HIV is associated with a multitude of renal pathologies that can involve the glomeruli, tubule, and interstitium. HIV is rarely associated with monoclonal gammopathy. We present a case of myeloma cast nephropathy in an HIV patient presenting with an AKI.
Case Description
58-year-old male patient with a past medical history of well controlled HIV and CKD with a baseline creatinine of 1.3 mg/dL presented to the hospital with abnormal labs. His creatinine was 7.1 mg/dL. Hemoglobin was 7.1 g/dL. Patient reported generalized weakness of 2 weeks duration.
On presentation, patient’s vital signs and physical exam were unremarkable. Repeat labs revealed a BUN of 61 mg/dL, creatinine of 6.9 mg/dL, and hemoglobin of 6.7 g/dL. Patient received IV hydration in the ER with no significant improvement in creatinine and was admitted for further workup.
Workup included SPEP which showed a monoclonal band in the gamma region; 9.2 g/dL. IgG was 10703 mg/dL and serum free kappa/lambda was 733.43. Renal biopsy showed light chain cast nephropathy, kappa light chain type in addition to minimal global glomerulosclerosis, mild interstitial fibrosis and mild to moderate arteriosclerosis. Multiple myeloma was suspected and was confirmed on bone biopsy which showed myeloma with kappa-restricted plasma cells, involving 80-90% of cellularity.
Patient was started on daratumumab/bortezomib/dexamethasone for treatment of multiple myeloma. Over a month, his creatinine has steadily decreased down to 2.6 mg/dL.
Discussion
HIV can commonly cause focal segmental glomerulosclerosis, collapsing variant. It is also known to cause pan-nephropathy including glomerular, interstitial, and tubular pathology. HIV can also be associated with polyclonal hypergammaglobulinemia though monoclonal gammopathy and myeloma cast nephropathy are rare. Treating the underlying multiple myeloma can help improve kidney disease. Clinicians should have a broad differential for AKI, including multiple myeloma, in HIV patients especially if they present with anemia as treating the underlying etiology is essential in treating the kidney disease.
Atypical casts on light microscopy and Kappa light chain on immunofluorescence