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J Nephrol. 2013 Nov-Dec;26(6):1192-4. doi: 10.5301/jn.5000275. Epub 2013 Nov 28.

Paraneoplastic minimal change nephropathy: a diagnostic challenge.

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  • 1Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong - Hong Kong.

Abstract

INTRODUCTION:

Myeloma-associated glomerulopathy could mimic idiopathic minimal change nephropathy, which poses a diagnostic challenge to nephrologists.

CASE REPORT:

A 60-year-old patient presented with nephrotic range of proteinuria. Serum creatinine level was normal. Immune markers and tumor markers were unrevealing. No monoclonal protein was detected on serum protein electrophoresis. Renal biopsy showed marked effacement of foot processes and no evidence of immunoglobulin or amyloid deposition on electron microscopy/immunofluorescence staining, compatible with idiopathic minimal change nephropathy histologically. However, proteinuria persisted despite steroid treatment. In view of the atypical course of the disease, workup for secondary glomerulopathy was repeated and paraproteinuria was unexpectedly found. Subsequent bone marrow examination confirmed light chain myeloma.

CONCLUSION:

Urine protein electrophoresis and serum/urine immunofixation are useful tests to detect the monoclonal protein in suspicious cases.

PMID:
24284527
[PubMed - indexed for MEDLINE]
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