Histological, histochemical and ultrastructural features of myeloma kidney

  • Conrad L. Pirani
Part of the Developments in Nephrology book series (DINE, volume 22)


Renal disease is a common and serious complication of plasma cell dyscrasias (PCD). In most clinical nephrology centers, a significant number of patients 50 years old or older presenting with proteinuria and/or renal insufficiency are diagnosed every year by serum and urine protein studies and by bone marrow biopsy as having developed kidney disease related to PCD. However, in some cases these laboratory studies are not revealing or are not done and such a diagnosis is made first by renal biopsy. Further, only by renal biopsy will it be possible to determine with certainty which of the several different patterns of renal involvement associated with PCD is present in an individual patient. There are six major morphologic patterns (Table 1) which have now been clearly characterized and differentiated and rarely occur in combination. These patterns have different pathogenetic mechanisms, different prognosis and different responses to therapy [1–9].


Multiple Myeloma Light Chain Multinucleated Giant Cell Distal Tubule Plasma Cell Dyscrasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Vcrroust P, Mery JP, Morel-Maroger L. Clauvel RP, Riebet G. Glomerular lesions in monoclonal gammopathies and mixed essential cryoglobulinemias IgG-IgM. In: Hamburger J. Crosnier J, Maxwell MH, eds. Advances in Nephrology. Vol. 1, Chicago: Year Book Publishers 1971:161 -94.Google Scholar
  2. 2.
    Schubert GE, Veigel J, Lennert K. Structure and function of the kidney in multiple myeloma. Virchows Arch A — Pathologic Anatomy 1972; 355: 135–57.CrossRefGoogle Scholar
  3. 3.
    Ganeval D, Junger P, Noel LH, Droz D. La nephropathie du myelome. Actual Nephrol HopNecker 1977; 7: 309–47.Google Scholar
  4. 4.
    Ganeval D, Mignon F, Preud’Homme JL, Noel LH, Morel-Maroger L, Droz D, Brouei JC, Mery J Ph, Grunfeld JP. Depots de chaines légères et d’immunoglobulines monoclonales: Aspects nephrologiques et hypotheses physiopathologiques. Actual Nephrol HopNecker 1981; 11: 179–214.Google Scholar
  5. 5.
    Gallo GR, Feiner HD, Buxbaum J. The kidney in lymphoplasmacytic disorders. In: Sommers SC, Rosen PP, eds. Pathology Annual 1982, Part I. Norwalk, Connecticut: Appleton-Century-Crofts 1982: 291–317.Google Scholar
  6. 6.
    Hill GS. Multiple myeloma, amyloidosis, Waldenstrom’s macroglobulinemia, cryoglobulinemias and benign monoclonal gammopathies. In: Heptinstall RH, ed. Pathology of the Kidney, 3rd ed. Boston: Little, Brown and Company 1983: 993–1068.Google Scholar
  7. 7.
    Pirani CL, Silva FG, Appel. Tubulo-interstitia disease in multiple myeloma and other non-renal neoplasias. In: Cotran R, ed., Brenner BM, Stein JR, series eds. Contemporary Issues in Nephrology, Vol. 10. New York: Churchill, Livingstone, 1983: 287– 384.Google Scholar
  8. 8.
    Silva FG, Pirani CL, Mesa-Tejada R, Williams GS. The kidney in plasma cell dyscrasias: A review and a clinicopathologic study of 50 patients. In: Fenoglio C, Wolff M, eds. Progress in Surgical Pathology. New York: Masson Publishers, 1984: 131–76.Google Scholar
  9. 9.
    Solomon A. Clinical implications of monoclonal light chains. Seminars in Oncology 1986; 13:341–9.PubMedGoogle Scholar
  10. 10.
    Cohen AH, Border WA. Myeloma kidney. An Immunomorphognetic study of renal biopsies. Lab Invest 1980; 42: 248–56.PubMedGoogle Scholar
  11. 11.
    Pirani CL, Silva F, D’Agati V, Chander P, Striker LMM. Renal lesions in plasma cell dyscrasias: Ultrastructural observations. Am J Kid Dis 1987; 10: 208–21.PubMedGoogle Scholar
  12. 12.
    Sessa A, Torri Tarelli L, Meroni M, Ferrario G, Giordano F, Volpi A. Multinucleated giant cells in myeloma kidney: An ultrastructural study. Applied Path 1984; 2: 185–94.Google Scholar
  13. 13.
    Levi DF, Williams RC Jr, Lindstron FD. Immunofluorescent studies of the myeloma kidney with special reference to light chain disease. Amer J Med 1968; 44: 922–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Start DA, Silva FG, Davis LD, D’Agati V, Pirani CL. Myeloma cast nephropathy: Immunohistochemical and lectin studies. Washington D.C.: Proc Am Soc Nephrology 1987.Google Scholar
  15. 15.
    Bell ET. Renal lesions associated with multiple myeloma. Am J Path 1933; 9: 393– 419.PubMedGoogle Scholar
  16. 16.
    Mizukami Y, Michigishi T, Kawato M, Matsubara F. Immunohistochemical and ultra- structural study of subacute thyroiditis, with special reference to multinucleated giant cells. Hum Path 1987; 18: 929–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Clyne DH, Kant KS, Pesce AJ, Pollak VE. Nephrotoxicity of low molecular weight protiens. Physicochemical interactions between myoglobin, hemoglobin, Bence Jones proteins and Tamm-Horsfall mucoproteins. Current Prob Clin Biochem 1979; 9: 299– 308.Google Scholar
  18. 18.
    Costanza DJ, Smoller M. Multiple myeloma with the Fanconi syndrome. Study of a case, with electron microscopy of the kidney. Amer J Med 1963; 34: 125–33.CrossRefGoogle Scholar
  19. 19.
    Clyne D, Brendstrup L, First MR, Pesce AJ, Finkel P, Pollak VE, Pirani CL. Renal effects of intraperitoneal kappa chain injection: Induction of crystals in renal tubular cells. Lab Invest 1974; 31: 131–42.PubMedGoogle Scholar
  20. 20.
    Koss M, Pirani CL, Osserman EP. Experimental Bence Jones cast nephropathy. Lab Invest 1976; 34: 579–91.PubMedGoogle Scholar
  21. 21.
    Clyne DH, Pesce AJ, Thompson RE. Nephrotoxicity of Bence Jones proteins in the rat: Importance of protein isoelectric point. Kid Intern 1979; 16: 345–52.CrossRefGoogle Scholar
  22. 22.
    Preud’Homme JL, Morel-Maroger L, Brouet JC, Cerf M, Mignon F, Guglielmi P, Seligmann M. Synthesis of abnormal immunoglobulins in lymphoplasmacytic disorders with visceral light chain deposition. Am J Med 1980; 69: 703–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Wochner RD, Strober W, Waldmann TA. The role of the kidney in the catabolism of Bence Jones proteins and immunoglobulins fragments. J Exp Med 1967; 126: 207–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Tan M, Epstein W. Polymer formation during the degradation of human light chain and Bence Jones proteins by an extract of the lysosomal fraction of normal human kidney. Immunochemistry 1972; 9: 9–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Mogielnicki RP, Waldmann TA, Strober W. Renal handling of low molecular weight proteins I. L-chain metabolism in experimental renal disease. J Clin invest 1971; 50: 901–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Clyne DH, Pollak VE. Renal handling and pathophysiology of Bence Jones proteins. Contrib Nephrol 1981; 24: 78–87.PubMedGoogle Scholar
  27. 27.
    Coward RA, Mallick NP, Deiamore IW. Tubular function in multiple myeloma. Clin Nephrol 1985; 24: 180–5.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers, Dordrecht 1988

Authors and Affiliations

  • Conrad L. Pirani
    • 1
  1. 1.Department of PathologyCollege of Physicians and Surgeons of Columbia UniversityNew YorkUSA

Personalised recommendations