SHM Converge Scientific Abstract ePoster Gallery-Beyond Anchoring: Recurrent Light Chain Deposition Disease Masquerading as Common Acute Kidney Injury Etiologies

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This case describes recurrent light chain deposition disease (LCDD), a form of monoclonal gammopathy of renal significance that can cause progressive kidney injury through deposition of light chains in renal structures. Because its presentation can resemble more common causes of kidney dysfunction, such as diabetic or hypertensive nephropathy, diagnosis may be delayed by anchoring on familiar explanations.<br /><br />An 83-year-old woman with multiple comorbidities, including HFpEF, atrial fibrillation, CLL, hypertension, hypothyroidism, and prior LCDD, was admitted with 10 days of worsening dyspnea, orthopnea, and leg edema. She had severe hypertension, acute kidney injury with creatinine rising from a baseline of 0.9 to 2.5 mg/dL, nephrotic-range proteinuria, monoclonal lambda light chains, elevated BNP, and a urine culture positive for Enterobacter. Initial findings suggested common competing causes such as hypertensive crisis, heart failure, and infection.<br /><br />Imaging showed pleural effusions and cardiomegaly with preserved ejection fraction, and renal ultrasound excluded obstruction. Renal biopsy was essential for diagnosis and demonstrated classic recurrent LCDD findings: linear lambda staining on glomerular and tubular basement membranes and powdery electron-dense deposits on electron microscopy.<br /><br />Because of the biopsy-confirmed diagnosis, clone-directed therapy with daratumumab and dexamethasone was started on hospital day 13. After treatment, creatinine peaked at 3.5 mg/dL but improved to 1.6 mg/dL, symptoms improved, proteinuria resolved, and lambda free light chains fell by more than 50% over two months.<br /><br />The key lesson is that recurrent LCDD should be considered in patients with AKI and monoclonal gammopathy, especially when comorbidities may obscure the true cause. Early renal biopsy and prompt hematology-directed therapy can stabilize kidney function and improve outcomes.

Asset Subtitle

Dana Toy

Meta Tag

Author List Brigid Larkin, Dana Toy, Haiyan Zhang

Category Clinical Vignettes

Concept Light Chain Deposition Disease

Concept Acute Kidney Injury

Concept Monoclonal Gammopathy

Concept Kidney Biopsy

Concept Clone-Directed Therapy

Distinguished Non-Finalist

Presenter Organization University of California San Diego, Division of Hospital Medicine

Presenting Author Dana Toy

Track Adult

Keywords

light chain deposition disease

LCDD

monoclonal gammopathy of renal significance

acute kidney injury

renal biopsy

lambda light chains

proteinuria

daratumumab

dexamethasone

kidney injury

Light Chain Deposition Disease

Acute Kidney Injury

Monoclonal Gammopathy

Kidney Biopsy

Clone-Directed Therapy