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Indian J Nephrol. 2019 Jan-Feb;29(1):65-69. doi: 10.4103/ijn.IJN_384_17.

Missed Monoclonal Disease Manifesting in Early Post-renal Transplant Period.

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Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pathology, Medicos Centre, Chandigarh, India.


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.


Cast nephropathy; multiple myeloma; tubulopathy

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