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Progression of Monoclonal Gammopathy with Undetermined Significance to Multiple Myeloma Diagnosed by Kidney Biopsy: A Case Report.

Kim JH, Kim JW, Kim YN, Kim HI, Kim JY, Kwon GY, Kim K, Jang HR - Case Rep Nephrol Dial (2015)

Bottom Line: During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein.Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia.The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Monoclonal gammopathy with undetermined significance (MGUS) carries a risk of progression to multiple myeloma, and progression is usually diagnosed with changes in M-protein or bone marrow biopsy. We report a case of 62-year-old female patient showing MGUS progression to multiple myeloma without significant changes in M-protein but diagnosed by kidney biopsy. During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein. Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia. The progression of MGUS to multiple myeloma was diagnosed by this kidney biopsy. The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

No MeSH data available.


Related in: MedlinePlus

Clinical course from MGUS to multiple myeloma before and after chemotherapy. a The second kidney biopsy was performed when both azotemia and proteinuria were aggravated without elevation of serum M-protein. After 8 cycles of chemotherapy, serum creatinine levels decreased significantly. b Spot urine protein-to-creatinine levels were also reduced by chemotherapy. c–e Serum M-protein levels and the κ/λ FLC ratio as well as serum κ FLC concentration were normalized after chemotherapy.
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Figure 2: Clinical course from MGUS to multiple myeloma before and after chemotherapy. a The second kidney biopsy was performed when both azotemia and proteinuria were aggravated without elevation of serum M-protein. After 8 cycles of chemotherapy, serum creatinine levels decreased significantly. b Spot urine protein-to-creatinine levels were also reduced by chemotherapy. c–e Serum M-protein levels and the κ/λ FLC ratio as well as serum κ FLC concentration were normalized after chemotherapy.

Mentions: A bone marrow biopsy showed normocellular marrow with proliferation of monoclonal plasma cells, suggesting the progression of MGUS to plasma cell myeloma (IgG, κ). A skeletal X-ray survey found compression fractures in the T8 and T9 vertebral bodies. A subsequent spine MRI revealed a focal hypointense lesion in the right articular process of the T5 and T7 vertebral bodies involved by multiple myeloma. Finally, she was diagnosed with multiple myeloma involving kidney and bone. She then began chemotherapy with a regimen of melphalan/dexamethasone weekly to treat the multiple myeloma. After 4 cycles of chemotherapy over 5 months, complete remission was achieved. The serum creatinine level decreased to 1.33 mg/dl, and the spot urine protein-to-creatinine ratio also decreased to 0.27 mg/mg (fig. 2). No abnormal band was observed on immunofixation tests of serum or spot urine. After 8 cycles of chemotherapy, serum creatinine was normalized to the level of 1.05 mg/dl, and spot urine protein-to-creatinine ratio decreased to 0.22 mg/mg.


Progression of Monoclonal Gammopathy with Undetermined Significance to Multiple Myeloma Diagnosed by Kidney Biopsy: A Case Report.

Kim JH, Kim JW, Kim YN, Kim HI, Kim JY, Kwon GY, Kim K, Jang HR - Case Rep Nephrol Dial (2015)

Clinical course from MGUS to multiple myeloma before and after chemotherapy. a The second kidney biopsy was performed when both azotemia and proteinuria were aggravated without elevation of serum M-protein. After 8 cycles of chemotherapy, serum creatinine levels decreased significantly. b Spot urine protein-to-creatinine levels were also reduced by chemotherapy. c–e Serum M-protein levels and the κ/λ FLC ratio as well as serum κ FLC concentration were normalized after chemotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608663&req=5

Figure 2: Clinical course from MGUS to multiple myeloma before and after chemotherapy. a The second kidney biopsy was performed when both azotemia and proteinuria were aggravated without elevation of serum M-protein. After 8 cycles of chemotherapy, serum creatinine levels decreased significantly. b Spot urine protein-to-creatinine levels were also reduced by chemotherapy. c–e Serum M-protein levels and the κ/λ FLC ratio as well as serum κ FLC concentration were normalized after chemotherapy.
Mentions: A bone marrow biopsy showed normocellular marrow with proliferation of monoclonal plasma cells, suggesting the progression of MGUS to plasma cell myeloma (IgG, κ). A skeletal X-ray survey found compression fractures in the T8 and T9 vertebral bodies. A subsequent spine MRI revealed a focal hypointense lesion in the right articular process of the T5 and T7 vertebral bodies involved by multiple myeloma. Finally, she was diagnosed with multiple myeloma involving kidney and bone. She then began chemotherapy with a regimen of melphalan/dexamethasone weekly to treat the multiple myeloma. After 4 cycles of chemotherapy over 5 months, complete remission was achieved. The serum creatinine level decreased to 1.33 mg/dl, and the spot urine protein-to-creatinine ratio also decreased to 0.27 mg/mg (fig. 2). No abnormal band was observed on immunofixation tests of serum or spot urine. After 8 cycles of chemotherapy, serum creatinine was normalized to the level of 1.05 mg/dl, and spot urine protein-to-creatinine ratio decreased to 0.22 mg/mg.

Bottom Line: During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein.Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia.The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Monoclonal gammopathy with undetermined significance (MGUS) carries a risk of progression to multiple myeloma, and progression is usually diagnosed with changes in M-protein or bone marrow biopsy. We report a case of 62-year-old female patient showing MGUS progression to multiple myeloma without significant changes in M-protein but diagnosed by kidney biopsy. During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein. Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia. The progression of MGUS to multiple myeloma was diagnosed by this kidney biopsy. The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

No MeSH data available.


Related in: MedlinePlus