Nonsecretory Myeloma Associated with Nodular Glomerulosclerosis

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Abstract
A patient with nonsecretory multiple myeloma in association with nodular glomerulosclerosis is reported. The clinical course was characterized by rapidly progressing renal insufficiency terminating in uremia within 3 mo. Histological investigation of the kidney revealed extensive nodular formations in the mesangial areas consisting of basement membrane-like material, in places with content of fibrils. Immunofluorescence demonstrated deposition of .kappa. chains. Amyloid was not present. Routine methods for investigation of serum and urine showed severe hypogammaglobulinemia without M-components. Using a sensitive radioimmunoassay for free L chains, an abnormal non-dissociable .kappa. chain polymer with a MW of 55,000 was found in serum and urine. Apparently, mesangial accumulation of paraproteins induce an increased synthesis of basement membrane material leading to formation of the nodules. Abnormal polymerization of .kappa. chains might provoke the formation of the glomerular nodules.