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  • Clinicopathological features and outcomes of coexistent light chain cast nephropathy and light chain deposition disease in patients with newly diagnosed multiple myeloma

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Original research
Clinicopathological features and outcomes of coexistent light chain cast nephropathy and light chain deposition disease in patients with newly diagnosed multiple myeloma
  1. Zi-Shan Lin1,
  2. Xu Zhang1,2,
  3. Dan-Yang Li1,2,
  4. Xiao-Juan Yu1,
  5. Ai-Bo Qin1,
  6. Yujun Dong3,
  7. Fu-De Zhou1,
  8. Suxia Wang1,2,
  9. Ming-Hui Zhao1
  1. 1 Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
  2. 2 Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
  3. 3 Department of Haematology, Peking University First Hospital, Beijing, China
  1. Correspondence to Dr Fu-De Zhou, Peking University First Hospital Department of Nephrology, Beijing 100034, China; zhoufude1801{at}vip.sina.com; Professor Suxia Wang; suxiawang{at}bjmu.edu.cn

Abstract

Aims A varying proportion of patients with multiple myeloma suffer from more than one type of kidney disease simultaneously, of which the most common pattern is coexistent light chain cast nephropathy and light chain deposition disease (LCCN+LCDD). We investigated clinicopathological characteristics and outcomes of LCCN+LCDD in comparison with pure LCCN and pure LCDD.

Methods We retrospectively analysed 45 newly diagnosed multiple myeloma patients with pure LCCN (n=26), LCCN +LCDD (n=9) and pure LCDD (n=10) between 2000 and 2019 at Peking University First Hospital.

Results Pathologically, patients with LCCN+LCDD were more likely to have λ light chain isotype and presented atypical features of LCDD including less nodular glomerulosclerosis and less deposit distribution than patients with pure LCDD. In clinical characteristics, patients with LCCN +LCDD and patients with pure LCCN shared similar features. The death-censored renal survival in patients with LCCN +LCDD was similar to patients with pure LCCN but worse than patients with pure LCDD, but the overall survival was much better than patients with LCCN alone and similar to patients with pure LCDD. For patients with pure LCCN, the independent predictor of death-censored renal survival was lactate dehydrogenase, and the independent predictors of overall survival were the mean number of casts and serum albumin.

Conclusions Patients with LCCN+LCDD had similar renal outcome compared with patients with pure LCCN but the overall survival is much better. Thus, for patients with LCCN, especially those with λ restriction, pathologists should carefully evaluate the kidney specimens to exclude the possibility of combined LCDD.

  • multiple myeloma
  • nephrology
  • antibodies
  • monoclonal

Data availability statement

Data are available on reasonable request. The data generated and analysed during the present study are under the domain of the corresponding author and will be made available on request and evaluation.

https://doi.org/10.1136/jclinpath-2021-207449

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    Data availability statement

    Data are available on reasonable request. The data generated and analysed during the present study are under the domain of the corresponding author and will be made available on request and evaluation.

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    Footnotes

    • Z-SL and XZ are joint first authors.

    • Handling editor Dhirendra Govender.

    • Z-SL and XZ contributed equally.

    • Contributors Z-SL and XZ contributed equally to this work. Z-SL contributed to the concept and design, collected the data, performed the statistical analysis and wrote the manuscript. XZ revised this manuscript and interpreted the histopathological data; D-YL, A-BQ, YD collected the data. XZ, SW and X-JY reviewed the kidney pathologies. F-DZ designed, supervised the study and revised it critically. M-HZ revised the manuscript. All authors approved the final version of the manuscript.

    • Funding This work was supported by the National Natural Science Foundation of China (grant number: 82070747) and CAMS Innovation Fund for Medical Sciences (grant number: 2019-I2M-5–046).

    • Disclaimer The funders had no role in study design, data collection and analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

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