{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:11:37Z","timestamp":1779340297853,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Light chain deposition disease (LCDD) is characterized by the deposition of monotypic immunoglobulin light chains in multiple organs. The kidneys are usually affected in cases of LCCD, and they typically present with mesangial nodule formation, extensive monoclonal light chain deposition, proteinuria, and renal insufficiency. We report a rare case of LCDD that presented with bone pain and proximal amyosthenia secondary to renal tubular phosphate loss. A 42-year-old woman presented with progressive pain in the waist and bilateral hips, along with increasing amyosthenia in both lower limbs that had persisted for more than a year. Upon investigation, she was diagnosed with hypophosphatemic osteomalacia (HO). She also had aminoaciduria, renal glucosuria, hypokalemia, hypouricemia, and renal tubular proteinuria with elevated serum kappa light chains. A renal biopsy revealed the presence of fibrillar deposits of kappa light chains along the glomerular basement membranes, as observed using electron microscopy and immunofluorescence. Congo red staining was negative. Based on the \u200cfinding of abnormal plasma cells comprising 1.1%\u200c of cellular elements in a bone marrow biopsy, we made a diagnosis of monoclonal gammopathy of renal significance. The patient received chemotherapy and exhibited positive clinical and biochemical responses. This case describes a unique presentation of renal injury due to LCDD masquerading as HO. The aim of this report is to highlight that HO in adults is usually acquired and that addressing the underlying etiology can result in a successful cure.<\/jats:p>","DOI":"10.3389\/fmed.2026.1849258","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:45:59Z","timestamp":1779338759000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Light chain deposition disease masquerading as hypophosphatemic osteomalacia: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiannan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Bing","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maodong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Song","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2805","DOI":"10.1182\/blood-2015-07-658872","article-title":"Natural history and outcome of light chain deposition disease","volume":"126","author":"Sayed","year":"2015","journal-title":"Blood"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1053\/snep.2002.33673","article-title":"Kidney and liver involvement in monoclonal light chain disorders","volume":"22","author":"Pozzi","year":"2002","journal-title":"Semin Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"F521","DOI":"10.1152\/ajprenal.1997.272.4.F521","article-title":"Receptor-mediated endocytosis of immunoglobulin light chains by renal proximal tubule cells","volume":"272","author":"Batuman","year":"1997","journal-title":"Am J Phys"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1007\/s00277-016-2659-1","article-title":"Clinicopathological characteristics and outcomes of light chain deposition disease: an analysis of 48 patients in a single chinese center","volume":"95","author":"Li","year":"2016","journal-title":"Ann Hematol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e687","DOI":"10.1016\/j.amjmed.2020.03.020","article-title":"Hypophosphatemic osteomalacia due to adefovir-induced fanconi syndrome","volume":"133","author":"Leungsuwan","year":"2020","journal-title":"Am J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s00198-020-05622-7","article-title":"A unique case of light chain (AL) amyloidosis masquerading as hypophosphatemic osteomalacia","volume":"32","author":"Malhotra","year":"2021","journal-title":"Osteoporos Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"462","DOI":"10.3760\/cma.j.cn311282-20240516-00198","article-title":"Practice guideline on the diagnosis and treatment of hypophosphataemic rickets\/osteomalacia","volume":"40","year":"2024","journal-title":"Chin J Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e12027","DOI":"10.1097\/MD.0000000000012027","article-title":"Acquired fanconi syndrome secondary to light chain deposition disease associated with monoclonal gammopathy of renal significance: a case report","volume":"97","author":"Tu","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/00005792-200005000-00002","article-title":"Adult fanconi syndrome secondary to light chain gammopathy. Clinicopathologic heterogeneity and unusual features in 11 patients","volume":"79","author":"Messiaen","year":"2000","journal-title":"Medicine (Baltimore)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1002\/ajh.24528","article-title":"Outcomes of patients with renal monoclonal immunoglobulin deposition disease","volume":"91","author":"Kourelis","year":"2016","journal-title":"Am J Hematol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"231","DOI":"10.2215\/CJN.08640811","article-title":"Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution","volume":"7","author":"Nasr","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1038\/ki.2014.408","article-title":"Diagnosis of monoclonal gammopathy of renal significance","volume":"87","author":"Bridoux","year":"2015","journal-title":"Kidney Int"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1681\/ASN.V1271558","article-title":"Light chain deposition disease: a model of glomerulosclerosis defined at the molecular level","volume":"12","author":"Ronco","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1894","DOI":"10.1093\/ndt\/gfu045","article-title":"Light chain deposition disease without glomerular proteinuria: a diagnostic challenge for the nephrologist","volume":"29","author":"Sicard","year":"2014","journal-title":"Nephrol Dial Transplant"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1097\/MNH.0000000000000201","article-title":"Spectrum of manifestations of monoclonal gammopathy-associated renal lesions","volume":"25","author":"Sethi","year":"2016","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3760\/cma.j.issn.0253-2727.2020.01.017","article-title":"Advances in Diagnosis and Treatment of Monoclonal Immunoglobulin Deposition Disease (In Chinese)","volume":"41","author":"Zhao","year":"2020","journal-title":"Chin J Hematol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"134","DOI":"10.3109\/01913123.2011.642464","article-title":"Light-chain deposition disease of the kidney: a case report","volume":"36","author":"Darouich","year":"2012","journal-title":"Ultrastruct Pathol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1080\/01913120701854002","article-title":"Morphologic heterogeneity of renal light-chain deposition disease","volume":"32","author":"Gokden","year":"2008","journal-title":"Ultrastruct Pathol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.1681\/ASN.2015020185","article-title":"Light Chain Proximal Tubulopathy: Clinical and Pathologic Characteristics in the Modern Treatment Era","volume":"27","author":"Stokes","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.5858\/arpa.2013-0493-OA","article-title":"Proximal tubulopathies associated with monoclonal light chains: the spectrum of clinicopathologic manifestations and molecular pathogenesis","volume":"138","author":"Herrera","year":"2014","journal-title":"Arch Pathol Lab Med"},{"key":"ref21","first-page":"853","volume-title":"Heptinstall\u2019s Pathology of the Kidney","author":"Herrera","year":"2006"},{"key":"ref22","first-page":"343","volume-title":"Silva\u2019s Diagnostic Renal Pathology","author":"Herrera","year":"2009"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1046\/j.1523-1755.2002.00501.x","article-title":"The tandem endocytic receptors megalin and cubilin are important proteins in renal pathology","volume":"62","author":"Verroust","year":"2002","journal-title":"Kidney Int"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1038\/nrm778","article-title":"Megalin and cubilin: multifunctional endocytic receptors","volume":"3","author":"Christensen","year":"2002","journal-title":"Nat Rev Mol Cell Biol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"497","DOI":"10.3760\/cma.j.issn.0529-5807.2003.06.101","article-title":"Protein chemistry determines light chain-mediated renal damage in patients with plasma cell dyscrasias: a molecular understanding of variable manifestations","volume":"32","author":"Herrera","year":"2003","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1159\/10.1159\/000173861","article-title":"Effect of myeloma light chains on phosphate and glucose transport in renal proximal tubule cells","volume":"17","author":"Batuman","year":"1994","journal-title":"Ren Physiol Biochem"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1159\/000157137","article-title":"Ultrastructural immunogold labeling patterns--image processing, mapping and quantitative microanalysis of antigenic sites in renal biopsies and neoplasms","volume":"8","author":"Herrera","year":"1989","journal-title":"Pathol Immunol Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.kint.2020.09.013","article-title":"Untangling immunotactoid glomerulopathy in the MGRS era","volume":"99","author":"Hogan","year":"2021","journal-title":"Kidney Int"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1016\/S0140-6736(21)00477-3","article-title":"Immunotactoid glomerulopathy associated with monoclonal gammopathy","volume":"397","author":"Inotani","year":"2021","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1053\/j.ajkd.2015.08.002","article-title":"AJKD atlas of renal pathology: fibrillary glomerulonephritis","volume":"66","author":"Lusco","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1359\/JBMR.0301264","article-title":"FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis","volume":"19","author":"Shimada","year":"2004","journal-title":"J Bone Miner Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s00223-020-00691-6","article-title":"Tumor-Induced Osteomalacia","volume":"108","author":"Florenzano","year":"2021","journal-title":"Calcif Tissue Int"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.bone.2013.01.046","article-title":"Osteocyte regulation of phosphate homeostasis and bone mineralization underlies the pathophysiology of the heritable disorders of rickets and osteomalacia","volume":"54","author":"Feng","year":"2013","journal-title":"Bone"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"4088","DOI":"10.1210\/jc.2002-021919","article-title":"Fibroblast growth factor 23: a new clinical marker for oncogenic osteomalacia","volume":"88","author":"Nelson","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1656","DOI":"10.1056\/NEJMoa020881","article-title":"Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia","volume":"348","author":"Jonsson","year":"2003","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849258\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:46:12Z","timestamp":1779338772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849258\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":35,"alternative-id":["10.3389\/fmed.2026.1849258"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1849258","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"article-number":"1849258"}}