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CASE REPORT
Unusual morphology of amyloid cast nephropathy in renal biopsy portending poor prognosis
  1. Meyyappa Devan Rajagopal1,
  2. Rajesh Nachiappa Ganesh1,
  3. Sreejith Parameswaran2 and
  4. Dhanin Puthiyottil2
  1. 1 Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
  2. 2 Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
  1. Correspondence to Dr Rajesh Nachiappa Ganesh, drngrajesh{at}gmail.com

Abstract

Light chain cast nephropathy is the most frequent form of renal disease in plasma cell neoplasm showing precipitation of monoclonal immunoglobulin light chains in the lumen of the distal tubules. This has a typical morphological feature characterised by the presence of a fractured cast. In this article, we report an unusual case of light chain cast nephropathy exhibiting amyloidogenic potential with lamellated, spiculated appearance. These casts were positive for periodic acid–Schiff and Jones’ silver stain, fuchsinophilic in Masson trichrome stain and showed apple-green birefringence under polarised light in Congo red stain. Complete haematological evaluation confirmed the presence of underlying plasma cell myeloma. The connotation of intratubular amyloid cast lies in the fact that this may represent an early phenomenon during the development of light chain cast nephropathy-associated systemic amyloidosis and may precede the formation of light chain amyloid in renal or extrarenal location.

  • renal medicine
  • pathology
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Footnotes

  • Contributors All the authors have significantly contributed to the diagnosis and management of the patient from the time of presentation to follow-up. The patient was admitted and passed away in spite of the authors' best efforts. In view of the patient’s unusual presentation, his consent was sought for publication and he gave written consent. All the authors have actively contributed, have read and approved the final manuscript that is submitted. RNG: diagnosis, intellectual content, literature search, manuscript preparation, manuscript editing and manuscript review. MDR: diagnosis, intellectual content, literature search, manuscript preparation, manuscript editing and manuscript review. SP: clinical work-up, management of patient, intellectual content and manuscript review. DP: clinical work-up, management of patient, intellectual content and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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