Urinary monoclonal FLCs kappa (Bence Jones proteinuria) were present and serum immunoglobulins were slightly reduced

Urinary monoclonal FLCs kappa (Bence Jones proteinuria) were present and serum immunoglobulins were slightly reduced. separate windows FIGURE 1 One sclerotic glomerulus, 2 with PAS positive mesangial deposits and duplication of Bowman capsule in one. (A) Arterial thickening of the parietal wall of two arteries (arrows). No sign of inflammation. PAS staining 20; (B) Artery with deposit of amorphous material, Masson trichrome staining 40. Positivity for Lambda light chain antibody in glomerular deposits (C) 40 and prevalence for Kappa light chain antibody Hydrocortisone(Cortisol) (D) 40. Congo reddish and Thioflavin\T were negative (not shown) Medullary osteobiopsy found 16% of clonal immunophenotype kappa plasma cells allowing the diagnosis of Multiple Myeloma (MM) with LCDD. No osteolytic lesions were present at the CT scan and echocardiogram was normal. Treatment with Bortezomib/Dexametasone (2.52?mg/40?mg) was Hydrocortisone(Cortisol) able to induce after 25?days a remarkable reduction of sFLCs kappa, the urinary FLCs disappeared and after 3?months the treatment was interrupted. The patient was then found suitable for autologous bone marrow BAX transplant. Approximately 50% of patients with MM experiences acute kidney injury (AKI) or CKD and severe AKI requiring dialysis generally occurs in 1C3% of these patients with reports in up to 12%.2 LCDD Hydrocortisone(Cortisol) with low or no glomerular proteinuria has been reported only in 1% of all the renal biopsy proven diagnoses. Due to the CKD of unknown origin that our patient presented at the admission in our Unit, renal biopsy was performed allowing the diagnosis. In the absence of significant proteinuria, in fact, paraproteinemias are not, generally, fully studied. This case confirms the need of an accurate diagnostic workup for monoclonal gammopathy, including the determination of FLCs. The need of renal biopsy in patients with CKD of unknown origin, even without significant proteinuria, becomes therefore crucial for LCCD diagnosis. Early recognition of MM and its complications is extremely important, given the positive renal outcome following the timely clone\directed therapy in addition to the autologous stem cells’ transplant.3 CONFLICT OF INTEREST The authors declare no conflict of interest. REFERENCES 1. Sicard A, Karras A, Goujon JM, et al. Light chain deposition disease without glomerular proteinuria: a diagnostic challenge for the nephrologist. Nephrol Dial Transplant. 2014;29:1894\1902. [PubMed] [Google Scholar] 2. Knudsen LM, Hjorth M, Hippe E. Renal failure in multiple myeloma: reversibility and impact on the prognosis. Nordic Myeloma Study Group. Eur J Haematol. 2000;65:175\181. [PubMed] [Google Scholar] 3. Jan A, Haynes R, Kothari J, Khera A, Soares M, Ramasamy K. Pathophysiology and management of monoclonal gammopathy of renal significance. Blood Adv. 2019;3:2409\2423. [PMC free article] [PubMed] [Google Scholar].