Abstract |
Patients with light-chain deposition disease (LCDD) frequently do not meet criteria for myeloma. In such cases, despite low tumor burden, the circulating monoclonal immunoglobulins cause renal damage, are responsible for post-transplant recurrence, and are rightly categorized as monoclonal gammopathy of renal significance (MGRS) requiring chemotherapy. A 65-year male with uncharacterized nodular glomerulopathy presented with proteinuria 3 years postrenal transplant. His allograft biopsies were diagnostic of light-chain deposition disease (likely recurrent), and in the absence of myeloma, he was labeled as MGRS. Based on the limited literature available, he was treated with bortezomib which resulted in normalization of serum-free light-chain ratios and resolution of proteinuria. He, however, later succumbed to complications of chemotherapy. This case highlights the diagnostic difficulties in LCDD, the importance of an accurate pretransplant diagnosis, and treatment of the malignant clone, in the absence of which post-transplant management of recurrence is challenging with poor outcomes.
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Authors | Aruna Nambirajan, Dipankar Bhowmik, Geetika Singh, Sanjay Kumar Agarwal, Amit Kumar Dinda |
Journal | Transplant international : official journal of the European Society for Organ Transplantation
(Transpl Int)
Vol. 28
Issue 3
Pg. 375-9
(Mar 2015)
ISSN: 1432-2277 [Electronic] Switzerland |
PMID | 25441103
(Publication Type: Case Reports, Journal Article)
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Copyright | © 2014 Steunstichting ESOT. |
Chemical References |
- Antineoplastic Agents
- Immunoglobulin Light Chains
- Bortezomib
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Topics |
- Aged
- Antineoplastic Agents
(therapeutic use)
- Biopsy
- Bortezomib
(therapeutic use)
- Humans
- Immunoglobulin Light Chains
(metabolism)
- Kidney
(pathology)
- Kidney Failure, Chronic
(surgery)
- Kidney Transplantation
(adverse effects)
- Male
- Monoclonal Gammopathy of Undetermined Significance
(diagnosis, etiology, therapy)
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