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Shimamura Y, Ogawa Y, Takizawa H, et al. Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy. Cureus. 2021;13(5):e15102doi: 10.7759/cureus.15102.
Shimamura, Y., Ogawa, Y., Takizawa, H., Hayashi, T., & Sakurai, Y. (2021). Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy. Cureus, 13(5), e15102. https://doi.org/10.7759/cureus.15102
Shimamura, Yoshinosuke, et al. "Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy." Cureus vol. 13,5 (2021): e15102. doi: https://doi.org/10.7759/cureus.15102
Shimamura Y, Ogawa Y, Takizawa H, Hayashi T, Sakurai Y. Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy. Cureus. 2021 May 18;13(5):e15102. doi: 10.7759/cureus.15102. PMID: 34159010; PMCID: PMC8212893.
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Cureus. 2021 May 18;13(5):e15102. doi: 10.7759/cureus.15102.

Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy.

Cureus

Yoshinosuke Shimamura, Yayoi Ogawa, Hideki Takizawa, Toshiaki Hayashi, Yasuo Sakurai

Affiliations

  1. Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, JPN.
  2. Department of Renal Pathology, Hokkaido Renal Pathology Center, Sapporo, JPN.
  3. Department of Hematology, Teine Keijinkai Medical Center, Sapporo, JPN.
  4. Department of Radiology, Teine Keijinkai Medical Center, Sapporo, JPN.

PMID: 34159010 PMCID: PMC8212893 DOI: 10.7759/cureus.15102

Abstract

Light chain deposition disease (LCDD) is characterized by the deposition of monoclonal immunoglobulin light chains in the kidney, which can cause end-stage kidney disease if not treated. While kidney biopsy is required for definitive diagnosis, choosing an appropriate biopsy method may be problematic when examining patients with atrophic kidneys. A 66-year-old Japanese man was referred to our institution with a three-month history of leg edema. Clinical investigations revealed proteinuria levels of 7.5 g/day. CT-guided percutaneous kidney biopsy was selected as the biopsy method because atrophic kidneys were poorly visualized on ultrasonography. Kidney biopsy revealed nodular glomerulosclerosis, exclusive deposition of the κ chain, and powdery electron-dense deposits, all of which were indicative of LCDD. Bence-Jones protein was detected in the urine. The patient also had an abnormal serum-free light chain ratio. Bone marrow biopsy revealed multiple myeloma; therefore, the patient was diagnosed to have LCDD with multiple myeloma. The patient was treated with daratumumab, bortezomib, cyclophosphamide, and dexamethasone. After a one-year follow-up, the patient had hematological and renal responses without any treatment-related adverse effects. Our case demonstrates the effectiveness of daratumumab as a treatment for LCDD with nephrotic-range proteinuria. Additionally, we suggest that CT-guided kidney biopsy should be considered as a diagnostic test in patients with kidney atrophy when making a definitive diagnosis.

Copyright © 2021, Shimamura et al.

Keywords: bortezomib; computed tomography; daratumumab; kidney biopsy; light chain deposition disease

Conflict of interest statement

The authors have declared that no competing interests exist.

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