The focus of therapy of cast nephropathy, or" myeloma kidney," has been chemotherapy to
decrease production of the abnormal monoclonal immunoglobulin and immunoglobulin light
chain, known as Bence Jones protein. Little attention has been given to understanding and
disrupting the pathophysiologic mechanisms involved in production of intraluminal casts that
obstruct and ultimately destroy renal function. Myeloma casts develop in the distal nephron
when cast-forming light chains bind to a specific portion of Tamm-Horsfall glycoprotein …