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Kidney Res Clin Pract. 2016 Dec;35(4):259-262. Epub 2016 Jun 18.

Crystalline podocytopathy and tubulopathy without overt glomerular proteinuria in a patient with multiple myeloma.

Author information

1
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Graduate School of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
3
Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Medicine, National Police Hospital, Seoul, Korea.
4
Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Crystalline nephropathy is a rare yet well-known condition associated with multiple myeloma and other light chain-secreting disorders. Paraproteins that are resistant to proteolysis crystallize within proximal tubular cells and cause light-chain proximal tubulopathy, which presents clinically as Fanconi syndrome. Podocytes are rarely affected, and the crystalline inclusions within podocytes are typically precipitated, yielding significant glomerular proteinuria. Here we report a case of extensive crystalline inclusions primarily within podocytes and proximal tubules that presented only with Fanconi syndrome and renal insufficiency. Despite the presence of extensive crystalline inclusions in podocytes and diffuse foot process effacement, the patient had no clinical evidence suggestive of podocyte injury.

KEYWORDS:

Fanconi syndrome; Multiple myeloma; Nephropathy

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