Open AccessMissed monoclonal disease manifesting in early post-renal transplant period
Author(s) -
Navdeep Singh,
Navin Pattanashetti,
Kusum Joshi,
Harbir Singh Kohli,
Krishan Lal Gupta,
Raja Ramachandran
Publication year - 2018
Publication title -
indian journal of nephrology/indian journal of nephrology
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 24
eISSN - 1998-3662
pISSN - 0971-4065
DOI - 10.4103/ijn.ijn_384_17
Subject(s) - medicine , azotemia , tubulopathy , acute tubular necrosis , hemodialysis , dialysis , diabetic nephropathy , biopsy , renal biopsy , multiple myeloma , nephropathy , surgery , transplantation , plasmapheresis , kidney transplantation , nephrocalcinosis , kidney , urology , renal function , diabetes mellitus , endocrinology , antibody , immunology
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 2 nd 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.