Download U05-16912

U05-16912
U05-16912
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52 y old female with PMH of mild RA, increased LFT, asthma, atypical chest
pain, depression
Presented late 2004 with chronic abdo pain, had laparoscopic fibroid
removal and R salpingoophorectomy Feb 2005
Jan 2005: Serum albumin 38, creatinine 83
Prior dipsticks with intermittent blood and protein
Few weeks after d/c felt very SOB and attributed it to her asthma
Presented with SOB and volume overload in June 2005, found to have
bilateral PE, started on coumadin, no work up done
July 2005: U dipstick 3+ protein, creatinine 91, albumin 21, 24h Urine 8g
prot
Repeated abdo US showed normal kidneys, abnormal spleen ? Infiltration
vs. infarct
24h urine form ER: Bence Jones +, l light chains
serologies negative, SPEP negative, hct 0.41
August renal clinic: SBP in 90s, mild volume o/l, no rales, no heave, no
murmurs, JVP not high, minimal joint deformities in feet
Arranged heme consult and MRV
MRV negative, spleen enlarged
Biopsy
Immunofluorescence
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IgG – Negative
IgA – Negative
IgM – Mild to moderate mesangial staining
C3 – Negative
C1q – Negative
Kappa – Negative
Lambda – Moderate mesangial staining. Moderate
vascular staining
• Fibrinogen – Negative
• Albumin – Moderate hyaline droplet change in tubular
cytoplasm
IgM
Lambda
Lambda
Albumin
Electron Microscopy
Diagnosis
• Renal Amyloidosis associated
with lambda light chain disease