A Relapsing Acute Tubulointerstitial Nephritis as an Expression of a Kappa Light Chain Multiple Myeloma: A Case Report.

IF 0.9 Q4 UROLOGY & NEPHROLOGY
Case Reports in Nephrology and Dialysis Pub Date : 2025-06-26 eCollection Date: 2025-01-01 DOI:10.1159/000544930
Andrea Angioi, Nicola Lepori, Matteo Floris, Wisit Cheungpasitporn, Paola Bianco, Gianfranca Cabiddu, Antonello Pani
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引用次数: 0

Abstract

Introduction: Light chain-mediated acute tubulointerstitial nephritis (LCTIN) is a rare and underrecognized renal manifestation of plasma cell dyscrasias, including multiple myeloma. It presents as a dense interstitial inflammatory infiltrate involving polyclonal lymphocytes and plasma cells, often mimicking other forms of tubulointerstitial nephritis and delaying the correct diagnosis.

Case presentation: A 46-year-old man was initially managed as having drug-induced acute interstitial nephritis due to NSAID use, responding only transiently to steroids. Upon relapse with worsening kidney function, hypercalcemia, and systemic symptoms, a second kidney biopsy demonstrated again an intense tubulointerstitial infiltrate and κ-light chain proximal tubulopathy.

Conclusion: This case illustrates that LCTIN can mimic relapsing interstitial nephritis. Early recognition and appropriate plasma cell-targeted therapy may significantly improve renal outcomes and guide clinical management.

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复发急性肾小管间质性肾炎表现为Kappa轻链多发性骨髓瘤1例。
轻链介导的急性小管间质性肾炎(LCTIN)是一种罕见且未被充分认识的浆细胞病变的肾脏表现,包括多发性骨髓瘤。它表现为密集的间质性炎症浸润,累及多克隆淋巴细胞和浆细胞,常与其他形式的小管间质性肾炎相似,延误了正确的诊断。病例介绍:一名46岁男性,最初被诊断为使用非甾体抗炎药引起的药物性急性间质性肾炎,仅对类固醇有短暂反应。复发后伴有肾功能恶化、高钙血症和全身性症状,第二次肾活检再次显示强烈的小管间质浸润和κ-轻链近端小管病变。结论:本病例提示LCTIN可模拟间质性肾炎复发。早期识别和适当的浆细胞靶向治疗可显著改善肾脏预后和指导临床管理。
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来源期刊
CiteScore
1.20
自引率
0.00%
发文量
36
审稿时长
10 weeks
期刊介绍: This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of nephrology and dialysis, including genetic susceptibility, clinical presentation, diagnosis, treatment or prevention, toxicities of therapy, critical care, supportive care, quality-of-life and survival issues. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed.
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