Crystalglobulin
induced nephropathy is a known complication of paraproteinemias. A recent review In JASN
focuses on this presentation of kidney damage from paraproteins. Monoclonal proteins can also deposit in
the kidney as crystals and cause tissue damage. This happens in cases of light chain proximal tubulopathy,
crystal-storing histiocytosis, and crystalglobulinemia. Crystalglobulinemia
is a rare complication of multiple myeloma that results from
crystallization of monoclonal proteins in the systemic vasculature, leading to
vascular injury, thrombosis, and occlusion. One can observe diffuse rectangular,
rhomboid and sharp needle shaped hyaline-like crystals depositing in multiple organ systems,
including the kidneys, myocardium, coronary arteries, tricuspid and pulmonary valves, lungs, bone marrow and other
organs. Usually, this is a quick and drastic leading to AKI, and ESRD. The
reason why this happens is unclear. It
is possible that it related to the abnormal
glycosylation of light chains and their interactions with albumin. IgG k and IgG lambda chains both have been
reported to be involved. Heavy chains have also been reported. Both cases of MM and MGRS
have been reported to be present with crystalglobulinemia.
Fig 1: Crystals in urinary space
Fig 2: Intracardiac crystalline deposits
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