Previously healthy female with oliguric renal failure. 15% plasma cells in bone marrow. High ESR, free IgG-lambda light chains in serum. Renal biopsy with following questions: myeloma cast nephropathy, multiple myeloma-associated AL-amyloidosis or light chain deposition disease?
Immunofluorescence: Brightly fluorescent lambda light chain casts in tubular lumina.
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