PMC8462866_01
(a) Serum protein immunofixation electrophoresis shows decrease in albumin due to renal loss. (b) Serum immunofixation (IFE) shows no monoclonal protein detected
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Subsequent urine and serum protein electrophoresis noted high free lambda light chains of 26.84 mg/dL and 47.7 mg/dL, respectively, and a low Kappa/Lambda urine ratio of 0.77 (Figure 1A). Further work-up including serum immunofixation and flow cytometry were not consistent with multiple myeloma (Figure 1B).
Histopathology and staining of kidney biopsy
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A renal biopsy was performed and demonstrated renal amyloidosis of the AL type with monoclonal IgG lambda involving the glomeruli and arteriolar vessels (Figure 2).