Trombose de veia renal, doen a de depósito de cadeias leves e nefropatia dos cilindros em paciente com mieloma múltiplo Renal vein thrombosis, light-chain deposition disease and cast nephropathy in a multiple myeloma patient

Mulher de 56 anos, hipertensa há 16 anos em tratamento, apresenta quadro de dor torácica e dispnéia há 3 dias. A investiga o laboratorial demonstrou insuficiência renal aguda com indica o de hemodiálise. Após diálise, apesar de melhora clínico-laboratorial, apresentou fibrila o ventricular e parada cardiorrespiratória revertidas. Evoluiu oligúrica, sem déficits neurológicos. Foi iniciada investiga o laboratorial para mieloma múltiplo que demonstrou hipogamaglobulinemia sem pico monoclonal na eletroforese de proteínas. Durante a investiga o a paciente apresentou novo episódio de fibrila o ventricular e óbito. A autópsia demonstrou trombose de veia renal esquerda, mieloma múltiplo plasmacítico com acometimento de medula óssea, nefropatia por depósito difuso de cadeias leves kappa glomerular e tubular e nefropatia dos cilindros do mieloma. Este caso ilustra uma associa o incomum entre nefropatia dos cilindros, nefropatia por depósito de cadeias leves e trombose de veia renal em paciente com mieloma múltiplo e insuficiência renal aguda. A 56-year-old woman presented with thoracic pain and dyspnea for 3 days. She had been under treatment for systemic arterial hypertension for 16 years. Laboratory investigation showed acute renal failure with indication for hemodialysis. After dialysis, despite improvements in clinical and laboratory parameters, she had an episode of ventricular fibrillation and cardiac arrest which was promptly reverted. She was still oliguric but without neurological deficits. A laboratory work up for multiple myeloma was started. Serum protein electrophoresis showed hypogammaglobulinemia without a monoclonal peak. While on laboratory work up, the patient had another episode of ventricular fibrillation and died. The autopsy showed left renal vein thrombosis, bone marrow involvement by a plasmacytic myeloma, light-chain deposition disease with diffuse glomerular and tubular involvement and also myeloma cast nephropathy. This case illustrates a rarely documented association between myeloma cast nephropathy, renal light-chain deposition disease and renal vein thrombosis in a multiple myeloma patient with acute renal failure.