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Table 143-4

Renal Diseases Associated with Monoclonal Immunoglobulins

DiseaseNotes
Cast nephropathyMost common cause of CKD in myeloma
Tubular obstruction with light chains
Interstitial inflammation
Acute or chronic renal failure
Light chain deposition diseaseNephrotic syndrome, chronic renal failure, ~40% have associated myeloma
Heavy chain deposition diseaseNephrotic syndrome, chronic renal failure
Monoclonal immunoglobulin deposition diseaseNephrotic syndrome, chronic renal failure
AL amyloidosisNephrotic syndrome, cardiac/endocrine/neuropathic involvement
~10% have associated myeloma
Renal tubular dysfunction (RTA, nephrogenic DI, etc.)
HypercalcemiaWith myeloma
Hyperviscosity syndromeWith Waldenström's macroglobulinemia
Fanconi syndromeGlucosuria, aminoaciduria, phosphaturia, ± hypouricemia, proximal RTA, etc.

Abbreviations: CKD, chronic kidney disease; DI, diabetes insipidus; RTA, renal tubular acidosis.