World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

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Journal website http://www.wjnu.org

Case Report

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

Plasma Cell Leukemia Presenting as Acute Kidney Injury With Heavy Proteinuria

Figure

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

**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 publication	1984	2007	2006
Age at diagnosis	45	50	52	40
Gender	Female	Male	Female	Male
Lytic bone lesion	N/A	Present	None	Present
Hemoglobin	9.7 g/dL	5.8 g/dL	N/A	9.5 g/dL
Platelet count	N/A	31 × 10⁹/L	70 × 10⁹/L	143 × 10⁹/L
Calcium	9.6 mg/dL	7.5 mg/dL	N/A	10.2 mg/dL
Initial creatinine	2.5 mg/dL	8.3 mg/dL	3.7 mg/dL	5.1 mg/dL
BUN	41 mg/dL	190 mg/dL	N/A	39 mg/dL
Renal biopsy
LM	Performed	Not performed	Performed	Performed
IF	Performed	Not performed	Performed	Performed
EM	Performed	Not performed	Performed	Performed
Diagnosis	PCL involving kidney and kappa light-chain deposition disease	PCL involving kidney	PCL involving kidney	PCL involving kidney and lambda light-chain cast nephropathy
Treatment	Cyclophosphamide, phenylalanine mustard, vincristine sulfate, carmustine	Prednisone, dexamethasone, cyclophosphamide	Cyclophosphamide and radiation	Lenalidomide, Bortezomib and plasmapheresis + SCT
Remission/follow-up	Yes (after one cycle of chemo)/No	Unknown/No	No/No	Yes/24 months