Multiple intra-renal pathological injury patterns in resistant myeloma

Renal dysfunction in patients with multiple myeloma has a heterogeneous aetiology ranging from pre-renal, intra-renal to post-renal causes. Common pathological forms of paraproteinemic disease include cast nephropathy, amyloidosis and Immunoglobulin chain deposition disease. Infrequently cryoglobulinemic glomerulonephritis and light chain proximal tubulopathy have also been described. The presence of multiple intra-renal pathological injury patterns has been described only once previously with immunoglobulin light chains. We report a patient with long standing treatment resistant multiple myeloma and new onset progressive renal failure with heavy and light-chain amyloidosis, cast nephropathy and proximal tubulopathy on renal biopsy.