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A Relapsing Acute Tubulointerstitial Nephritis as an Expression of a Kappa Light Chain Multiple Myeloma: A Case
Andrea Angioi1, Nicola Lepori1,2, Matteo Floris1
1Nephrology, Dialysis and Transplantation Unit, "Giuseppe Brotzu" Hospital, Cagliari, Italy.
Introduction:
Light chain-mediated acute tubulointerstitial nephritis (LCTIN) is a rare and underrecognized renal manifestation of plasma cell dyscrasias, including multiple myeloma. It presents as a dense interstitial inflammatory infiltrate involving polyclonal lymphocytes and plasma cells, often mimicking other forms of tubulointerstitial nephritis and delaying the correct diagnosis.
Case Presentation:
A 46-year-old man was initially managed as having drug-induced acute interstitial nephritis due to NSAID use, responding only transiently to steroids. Upon relapse with worsening kidney function, hypercalcemia, and systemic symptoms, a second kidney biopsy demonstrated again an intense tubulointerstitial infiltrate and κ-light chain proximal tubulopathy.
Conclusion:
This case illustrates that LCTIN can mimic relapsing interstitial nephritis. Early recognition and appropriate plasma cell-targeted therapy may significantly improve renal outcomes and guide clinical management.
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