15th July 2024

Diagnosis

Although readily suspected in patients with known multiple myeloma, monoclonal-gammopathy associated with nephropathy should be included in the differential diagnosis of any patient presenting with renal failure.  The diagnosis can only be made definitively with a kidney biopsy but is often simply established by a raised creatinine, reduced creatinine clearance and identifying the presence of a monoclonal protein in the urine as well as ruling out other causes. Light chain casts will have an eosinophilic appearance on haematoxylin and eosin stain and a pale pink appearance on periodic acid-Schiff staining.