The aim of this case is to report a successful management of severe cholestasis and bile cast nephropathy secondary to anabolic steroids using plasma exchange.
Chang, "Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction," Kidney International, vol.
All two cases were diagnosed as myeloma-like cast nephropathy. In HIV positive patients biopsy finding confirmed HIV associated changes in addition to myeloma-like cast nephropathy.
Renal needle biopsy was done showing conventional HIV associated nephropathy with coexisting myeloma-like cast nephropathy. Light microscopy revealed foci of tubular cystic dilatation and diffuse tubular dilatation containing eosinophilic, Periodic Acid-Schiff (PAS) negative casts coupled with segmental collapse of capillary tufts and focal glomerulosclerosis.
The pathologic consequence is hemoglobin cast nephropathy which in our case led to acute renal failure and death.
Fogo, "Myoglobin cast nephropathy in a kidney transplant patient with normal creatine kinase," American Journal of Kidney Diseases, vol.
Comparison of the percentage of light chain
cast nephropathy cases (33% of all cases associated with plasma cell dyscrasia) with proximal tubular-centered cases (roughly 46% of all cases with underlying plasma cell dyscrasias) emphasizes that the total number of proximal tubulopathies indeed represents a very significant portion of all lesions observed.
Impact of free light chain haemodialysis in myeloma
cast nephropathy: a case-control study.
The measurement of serum concentration of the clonal FLCs and that of urine level of albumin may be considered the landmarks for screening algorithms in patients with
cast nephropathy [69].
In this study, FLC levels were not measured, and histologic evidence of
cast nephropathy was insufficient.
The most common cause of renal insufficiency in patients with multiple myeloma, occurring in approximately 30% of patients, is
cast nephropathy. (Leung, 2008).
(5-11) There are some morphologic patterns that are readily recognizable at the light microscopic level, especially when the manifestations are florid, including that of myeloma
cast nephropathy, nodular glomerulosclerosis associated with light or heavy chain deposition disease, and light and heavy chain (AL and AH) amyloidosis.
