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Year : 2019  |  Volume : 29  |  Issue : 1  |  Page : 50--52

Monoclonal gammopathy of renal significance triggered by viral E hepatitis

P Agrawal1, V Kumar2, A Kumar1, M. U. S Sachdeva3, P Malhotra4, R Nada1 
1 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Hematopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
R Nada
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India

Monoclonal gammopathy of undetermined significance does not have end organ damage, but a proportion of cases manifest with renal injury when it is called monoclonal gammopathy of renal significance (MGRS). Herein, we describe a case of acute hepatitis E infection, which precipitated the development of MGRS. The patient underwent kidney biopsy for elevated creatinine with clinical suspicion of drug-induced interstitial nephritis. On light microscopy, there were periodic acid–Schiff negative-fractured casts in tubules with giant cell reaction around them. The tubular epithelial cells showed intracytoplasmic bile pigment. On direct immunofluorescence, casts showed kappa restriction. A diagnosis of bilirubin proximal tubulopathy and light chain cast nephropathy was made, and possibility of myeloma was suggested. On further evaluation, κ:λ ratio was 27, β2 microglobulin was 8036 ng/ml, and bone marrow examination showed 5% plasma cells. There were no bony lesions, and serum calcium was 8.6 mg/dl. The present case is unique in two aspects. First, the patient developed MGRS triggered by acute hepatitis E in less than a month. Second, the MGRS lesion was manifested in the form of light chain cast nephropathy.

How to cite this article:
Agrawal P, Kumar V, Kumar A, Sachdeva M, Malhotra P, Nada R. Monoclonal gammopathy of renal significance triggered by viral E hepatitis.Indian J Nephrol 2019;29:50-52

How to cite this URL:
Agrawal P, Kumar V, Kumar A, Sachdeva M, Malhotra P, Nada R. Monoclonal gammopathy of renal significance triggered by viral E hepatitis. Indian J Nephrol [serial online] 2019 [cited 2023 Feb 1 ];29:50-52
Available from: https://www.indianjnephrol.org/article.asp?issn=0971-4065;year=2019;volume=29;issue=1;spage=50;epage=52;aulast=Agrawal;type=0