Plasma Cell Leukemia Presenting as Acute Kidney Injury With Heavy Proteinuria

Plasma cell leukemia (P CL) is a rare and aggressive malignancy of plasma cells with a poor prognosis. Direct renal involvement in PCL is rarely reported with only a few cases in the English literature. We described the clinical and pathologic findings of a 40-year-old African-American male with acute kidney injury (AKI) due to light-chain cast nephropathy and direct renal invasion by malignant plasma cells, diagnosed as having PCL on renal biopsy and successfully treated with aggressive plasmapharesis and allogeneic stem cell transplantation (SCT). To the best of our knowledge, this is the first case report of PCL diagnosed on kidney biopsy. Among the various clinical manifestations of PCL, AKI and proteinuria may be its initial presentation, illustrating the etiologic complexity of AKI. Successful treatment of cast nephropathy with plasma exchange and PCL by SCT was associated with recovery of renal function. World J Nephrol Urol. 2014;3(3):129-133 doi: http://dx.doi.org/10.14740/wjnu177w