U05-16912#868528420

52 y old female with PMH of mild RA, increased LFT, asthma, atypical chest pain, depression•Presented late 2004 with chronic abdo pain, had laparoscopic fibroid removal and R salpingoophorectomy Feb 2005•Jan 2005: Serum albumin 38, creatinine 83•Prior dipsticks with intermittent blood and protein•Few weeks after d/c felt very SOB and attributed it to her asthma•Presented with SOB and volume overload in June 2005, found to have bilateral PE, started on coumadin, no work up done•July 2005: U dipstick 3+ protein, creatinine 91, albumin 21, 24h Urine 8g prot•Repeated abdo US showed normal kidneys, abnormal spleen ? Infiltration vs. infarct•24h urine form ER: Bence Jones +, light chains•serologies negative, SPEP negative, hct 0.41•August renal clinic: SBP in 90s, mild volume o/l, no rales, no heave, no murmurs, JVP not high, minimal joint deformities in feet•Arranged heme consult and MRV

•MRV negative, spleen enlarged

Immunofluorescence

• IgG – Negative• IgA – Negative• IgM – Mild to moderate mesangial staining• C3 – Negative• C1q – Negative• Kappa – Negative• Lambda – Moderate mesangial staining. Moderate

vascular staining• Fibrinogen – Negative• Albumin – Moderate hyaline droplet change in tubular

cytoplasm

IgM

Lambda

Lambda

Albumin

Diagnosis

• Renal Amyloidosis associated with lambda light chain disease