case report Usefulness of the Free Light Chains Ratio in the Diagnosis of Light Chain Deposition Disease (LCDD): A Case Report.
Teresa Troiano1, Vincenzo Brescia1, Lucia De Marinis1, Brigida Giove1, Roberto Lovero1*, Pamela Patierno1, Vincenzo Montinaro2, Francesca Di Serio1
1Clinical Pathology Unit, Polyclinic of Bari, 70124 Bari, Italy
2U.O. Nefrologia Azienda Ospedaliera-Universitaria Consorziale Policlinico e Università degli Studi Aldo Moro, Bari. Italy
*Corresponding author: Roberto Lovero, Clinical Pathology Unit, and AOU Policlinico Consorziale di Bari - Ospedale Giovanni XXIII, Bari 70124, Italy.
Received Date: 01 February 2023
Accepted Date: 04 February 2023
Published Date: 07 February 2023
Citation: Troiano T, Brescia V, Marinis LD, Giove B, Lovero R, et al. (2023) Usefulness of the Free Light Chains Ratio in the Diagnosis of Light Chain Deposition Disease (LCDD): A Case Report. Ann Case Report 08: 1156. DOI: https://doi.org/10.29011/25747754.101156
Abstract
Background: Clinically Significant Monoclonal Gammopathies (MGCS) are a heterogeneous group of clinical pictures characterized by a clonal proliferation of B lymphocytes and/or plasma cells that produce a “toxic” monoclonal protein for some organs and tissues. Light Chain Deposition Disease (LCDD) is a clinical picture characterized by the deposition of monoclonal free light chains in the kidney, the main target organ, and in organs such as the liver and heart. In about 80% of cases the monoclonal free light chains are the kappa isotype, and form unorganized deposits at the level of the basement membranes of the glomeruli and renal tubules.
Case reports
A 64-year-old man with a clinical history of arterial hypertension, dependent edema, proteinuria, microhaematuria is admitted to the U.O. of Nephrology for the diagnostic classification of renal disease.
Results
The diagnostic work-up for plasma cell dyscrasias showed the presence of an altered kappa/lambda ratio without alterations of the serum protein electrophoretic tracing and without evidence of Monoclonal Immunoglobulin (MIg) at serum and urine immunofixation performed with High Resolution (HR) methods. Bone marrow biopsy showed < 10% plasmacytosis. Renal biopsy diagnosed Light Chian Deposition Disease (LCDD).
Conclusions
LCDD is a form of MGRS characterized by the deposition of monoclonal free light chains in the basement membranes of the glomerulus and renal tubule. The kappa/lamda ratio allowed to signal the presence of a small clone secreting monoclonal free light chains. In patients diagnosed with Monoclonal Gammopathies of Renal Significance (MGRS), timely therapy to eradicate the neoplastic clone can avoid the progression of irreversible renal organ damage.
Key Words: Light Chain Deposition Disease; Free Light Chains Ratio; Glomerular Disease; MGRS; Renal Biopsy