Light Chain-Associated Renal Disorders Clinical Presentation

Updated: Sep 10, 2019
  • Author: Malvinder S Parmar, MBBS, MS, FRCPC, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Patients with light-chain nephropathy may present with symptoms of underlying systemic disease and/or with symptoms of associated renal syndrome(s). Alternatively, these patients may be asymptomatic. Normal renal function is observed in 10-40% of patients with light-chain proteinuria. Many patients with multiple myeloma have no demonstrable renal dysfunction despite persistent light-chain proteinuria. The amount, type, or duration of light-chain proteinuria does not correlate with the level of renal dysfunction.

Symptoms of underlying systemic disease include the following:

  • Weakness or lethargy
  • Weight loss, anorexia
  • Bone pain occurs in 80% of patients with myeloma
  • Symptoms of peripheral neuropathy (eg, numbness and burning pain in the lower extremities)
  • Symptoms of compression fracture
  • Recurrent infections

Symptoms of acute kidney injury (5-30%) or chronic kidney disease (30-60%) may include peripheral edema and dyspnea.

Fanconi syndrome occurs in up to 30% of patients with light-chain proteinuria. Varying degrees of glucosuria, aminoaciduria, phosphaturia, lysozymuria, and proximal tubular acidosis can occur in these patients. Fanconi syndrome is associated almost exclusively with kappa light-chain proteinuria, with the exception of three patients reported with lambda light-chain proteinuria. [9]

 

Nephrotic syndrome is characterized by edema, hypoalbuminemia, and nephrotic range proteinuria (> 3 g of urine protein per d), this may occur in 30% of patients.

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Physical

Patients may have physical signs of underlying systemic illness and/or associated renal syndromes, such as the following:

  • Pallor
  • Cachexia
  • Dehydration
  • Hypertension
  • Edema
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