Nonsecretory myeloma associated with nodular glomerulosclerosis

A patient with nonsecretory multiple myeloma in associated with nodular glomerulosclerosis is reported. The clinical course was characterized by rapidly progressing renal insufficiency terminating in uremia within three months. Histological investigation of the kidney revealed extensive nodular formations in the mesangial areas consisting of basement membrane-like material, in places with content of fibrils. Immunofluorescence demonstrated deposition of kappa chains. Amyloid was not present. Routine methods for investigation of serum and urine showed severe hypogammaglobulinemia without M-components. Using a sensitive radioimmunoassay for free light chains, an abnormal non-dissociable kappa chain polymer with a molecular weight of 55 000 was found in serum and urine. The findings support the hypothesis that mesangial accumulation of paraproteins induce an increased synthesis of basement membrane material leading to formation of the nodules. Abnormal polymerization of kappa chains might provoke the formation of the glomerular nodules.