Missed monoclonal disease manifesting in early post-renal transplant period

• Published in: Indian journal of nephrology Vol. 29; no. 1; pp. 65 - 69
• Main Authors: Singh, N, Pattanashetti, N, Joshi, K, Kohli, H, Gupta, K, Ramachandran, R
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Acute kidney failure; Anemia; Biopsy; Blood; Blood transfusion; Care and treatment; Case Report; Case studies; Chemotherapy; Chronic kidney failure; Diabetes; Diabetic nephropathies; Diabetic nephropathy; Diabetic retinopathy; Diagnosis; Hemodialysis; Hemoglobin; Kidney diseases; Kidney transplantation; Multiple myeloma; Necrosis; Organ transplantation; Patients; Plasma exchange (Therapeutics); Proteins; Surgery; Transplants & implants; Tumors; Urine; Cast nephropathy; tubulopathy; multiple myeloma
• ISSN: 0971-4065; 1998-3662
• DOI: 10.4103/ijn.IJN_384_17

A 63-year-old diabetic gentleman with microvascular complications presented with advanced azotemia and anemia. He was stabilized with blood transfusion and hemodialysis. With the probable diagnosis of diabetic nephropathy-related end-stage renal disease, he underwent kidney transplantation. He had delayed graft function. Graft biopsy done on the 2nd postoperative day showed acute tubular necrosis. Graft biopsy repeated after 2 weeks for persistent graft dysfunction showed myeloma cast nephropathy (MCN) and light chain proximal tubulopathy. Work-up for multiple myeloma was positive. He was started on plasmapheresis and chemotherapy. However, he suffered sudden cardiac death during dialysis after 1 week. The presence of MCN in the early graft biopsy implies that it must have been the cause for his native kidney failure. Thus, renal failure in a diabetic should not always be presumed to be due to diabetic nephropathy, and kidney biopsy should be done in diabetics with atypical features.