World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc
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Case Report

Volume 3, Number 3, September 2014, pages 129-133

Plasma Cell Leukemia Presenting as Acute Kidney Injury With Heavy Proteinuria


Figure 1.
Figure 1. Figure 1. (A) Light-chain cast surronunded by giant cells (H&E, × 400). (B) Interstitial infiltration of leukemic plasma cells (H&E, × 400). (C) Immunohistochemical staining for CD138 highlighting plasma cells. (D) Silver stain showing normal glomeruli (× 400). (E) Tubular casts strongly positive for lambda chain (immunofluorescence × 400). (F) Electron micrograph showing unremarkable glomerulus. (G) Plasma cells in peripheral blood (Wright stain, × 100).


Table 1. Clinical Spectrum of Plasma Cell Leukemia Involving Kidney
LM: light microscopy; IF: immunofluorescence microscopy; EM: electron microscopy; N/A: not applicable; SCT: stem cell transplantation.
Year of publication198420072006
Age at diagnosis45505240
Lytic bone lesionN/APresentNonePresent
Hemoglobin9.7 g/dL5.8 g/dLN/A9.5 g/dL
Platelet countN/A31 × 109/L70 × 109/L143 × 109/L
Calcium9.6 mg/dL7.5 mg/dLN/A10.2 mg/dL
Initial creatinine2.5 mg/dL8.3 mg/dL3.7 mg/dL5.1 mg/dL
BUN41 mg/dL190 mg/dLN/A39 mg/dL
Renal biopsy
  LMPerformedNot performedPerformedPerformed
  IFPerformedNot performedPerformedPerformed
  EMPerformedNot performedPerformedPerformed
DiagnosisPCL involving kidney and kappa light-chain deposition diseasePCL involving kidneyPCL involving kidneyPCL involving kidney and lambda light-chain cast nephropathy
TreatmentCyclophosphamide, phenylalanine mustard, vincristine sulfate, carmustinePrednisone, dexamethasone, cyclophosphamideCyclophosphamide and radiationLenalidomide, Bortezomib and plasmapheresis + SCT
Remission/follow-upYes (after one cycle of chemo)/NoUnknown/NoNo/NoYes/24 months