Kidney Week

Abstract: PUB454

Complex Renal Involvement in Multiple Myeloma and Extramedullary Plasmacytoma: A Clinical Perspective

Session Information

• Publication Only

Category: Onconephrology

• 1700 Onconephrology

Authors

• Gonzalez, Carlos Brando, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico

Carlos Brando Gonzalez, MD

• Olivo Gutierrez, Mara Cecilia, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico

Mara Cecilia Olivo Gutierrez, MD

• Soto, Virgilia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico

Virgilia Soto, MD

• Sanchez Cardenas, Monica, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico

Monica Sanchez Cardenas

Introduction

This case involves a 43-year-old male patient with no prior comorbidities who was admitted to our unit with rapid deterioration of renal function and uremic syndrome. During evaluation, a left lung mass was detected.
The objective of this report is to present a clinical case featuring a large plasmacytoma and severe renal function impairment as the initial manifestation of Multiple Myeloma (MM) in a young and healthy man.

Case Description

A 43-year-old previously healthy man experienced symptoms of asthenia, adynamia, emesis, and wasting syndrome during the two weeks prior to hospital admission. Initial laboratory tests revealed severe renal impairment, with creatinine at 20.1 mg/dL and BUN at 107 mg/dL, with no significant abnormalities in blood cell count. During evaluation, a 24-hour urine protein test showed 630 mg/dL. Incidentally, a large pulmonary mass (8.4 x 13.1 x 10 cm) was detected in the left apex. A renal biopsy (image 1) revealed active tubulointerstitial nephritis with intratubular lambda (+) casts, as well as minimal glomerular and vascular amyloidosis. A biopsy of the pulmonary mass confirmed the histological diagnosis of plasmacytoma associated with multiple myeloma.

Discussion

Amyloidosis is a heterogeneous disease characterized by the deposition of insoluble and toxic fibrillar protein aggregates in various tissues. Renal involvement is a common complication of hematologic malignancies, with monoclonal gammopathy of undetermined significance (MGUS) being the most common form. The incidence of solitary plasmacytomas affecting only soft tissues ranges from 1.4-4.5%, with 34% located as paraeskeletal tumors.
The evaluation of new renal injury events in the context of newly appearing malignancies requires consideration of monoclonal disorders within the differential diagnosis; this is particularly true even in the context of solid tumors as the initial manifestation of the condition without significant abnormalities in blood cell counts.