Myeloma cell nephropathy is one type of renal involvement seen in patients with a plasma cell dyscrasia. The diagnosis may be suspected in a patient with Bence-Jones proteinuria but requires renal biopsy.


Synonym: Bence-Jones cast nephropathy, myeloma kidney



(1) The patient has a plasma cell dyscrasia.

(2) The kidney shows extensive renal tubular casts.

(3) The casts are often cracked (“brittle”).

(4) The casts consist mostly of a single monoclonal light chain.

(5) The casts may show apple green birefringence on Congo Red stain.


The casts may contain other serum proteins secondary to proteinuria.



(1) interstitial inflammation and inflammation about the casts

(2) interstitial fibrosis

(3) giant cell reaction

(4) tubular atrophy


Renal failure usually occurs if the condition is not diagnosed early and treatment started immediately.


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