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02-12-2009, 05:21 PM
Light Chain Cast Nephropathy

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman
With Assistance From Kim Solez, MD, of the National Kidney Foundation's cyberNephrologyTM Team

http://www2.ajkd.org/ajkd/atlas/32/4/small/fig01.jpg (http://www2.ajkd.org/ajkd/atlas/32/4/atlasf01.htm)
Fig 1. Tubular casts with surrounding syncytial giant cell reaction and chronic tubulointerstitial nephritis and fibrosis, diagnostic of myeloma cast nephropathy. The glomerulus on the right shows no lesions, although occasionally glomeruli may be involved with a paraprotein process such as light-chain deposition disease or amyloid in cases of myeloma cast nephropathy (hematoxylin & eosin; original magnification x100).

http://www2.ajkd.org/ajkd/atlas/32/4/small/fig02.jpg (http://www2.ajkd.org/ajkd/atlas/32/4/atlasf02.htm)
Fig 2. High power view of intratubular casts that appear fractured and very refractile with surrounding syncytial giant cell reaction. These findings are diagnostic of myeloma kidney. There is moderate interstitial fibrosis and lymphocytic infiltrate (PAS stain; original magnification x400).

http://www2.ajkd.org/ajkd/atlas/32/4/small/fig03.jpg (http://www2.ajkd.org/ajkd/atlas/32/4/atlasf03.htm)
Fig 3. Close-up of intratubular refractile casts with surrounding syncytial giant cell reaction with chronic tubulointerstitial nephritis and fibrosis, characteristic of myeloma cast nephropathy (PAS stain; original magnification x400).

http://www2.ajkd.org/ajkd/atlas/32/4/small/fig04.jpg (http://www2.ajkd.org/ajkd/atlas/32/4/atlasf04.htm)
Fig 4. Myeloma intratubular casts show a slightly wormy substructure with fractured ends, which may also be visualized by light microscopy (Fig 2) (transmission electron microscopy; original magnification x10,000).