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Lambda Light Chain Cast Nephropathy Caused by Splenic Marginal Zone Lymphoma
Joyce H Gu1, Nicholas Smothermon2, Jusnimrat Kohli2
1Medicine, Lake Erie College of Osteopathic Medicine, Greensburg, USA.
Insights
This case study details a patient with splenic marginal zone lymphoma who developed kidney injury due to light chain cast nephropathy. This rare complication highlights a serious risk associated with certain lymphomas.
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- Splenic marginal zone lymphoma (SMZL) is a rare B-cell lymphoma.
- Monoclonal gammopathy can indicate underlying plasma cell disorders or lymphoproliferative diseases.
- Renal injury in lymphoma patients can stem from various mechanisms, including direct infiltration or paraneoplastic syndromes.
Observation:
- An elderly male patient presented with symptoms of renal injury.
- Diagnostic workup revealed monoclonal gammopathy with elevated free lambda light chains.
- Bone marrow biopsy excluded multiple myeloma, while renal biopsy confirmed lambda light chain cast nephropathy.
Findings:
- The patient had splenic marginal zone lymphoma with monoclonal CD5+ B cells.
- Lambda light chain cast nephropathy was identified as the cause of renal failure.
- Despite interventions, the patient's condition worsened, leading to expiration.
Implications:
- This case underscores light chain cast nephropathy as a critical and rare complication of lymphomas.
- It emphasizes the importance of considering renal pathology in lymphoma patients with declining kidney function.
- Early recognition and management of light chain nephropathy may improve outcomes in lymphoma patients.
Abstract:
We report an interesting case of an elderly male patient with splenic marginal zone lymphoma with a monoclonal cluster of differentiation (CD)5+ B cells. The patient developed signs of renal injury and was evaluated via serum protein electrophoresis and immunofixation electrophoresis, which revealed monoclonal gammopathy with elevated free lambda light chain. However, a bone biopsy ruled out a diagnosis of multiple myeloma. Upon renal biopsy, the patient was diagnosed with lambda light chain cast nephropathy. However, the patient's condition further deteriorated, and the patient eventually expired. This case highlights light chain cast nephropathy as a rare yet serious complication of lymphomas and, in particular, splenic marginal zone lymphoma.
