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Review Question - QID 216370

Multiple Myeloma Studies Invasive studies QID: 216370 (M2.OMB.4876)
In scope icon M 10
QID 216370 (Type "216370" in App Search)
A 70-year-old man presents to his primary care doctor for 6 months of fatigue and back pain. He is otherwise healthy and his only medication is a daily baby aspirin. His temperature is 98.0°F (36.6°C), blood pressure is 122/84 mmHg, pulse is 90/min, and respirations are 18/min. His physical exam is notable for tenderness over the lumbar spine. He walks with a steady gait and has 5/5 strength in the muscles of the lower and upper extremities. Initial laboratory testing demonstrates the following:

Hemoglobin: 10.4 g/dL
Creatinine: 2.0 mg/dL
Ca2+: 11.2 mg/dL

Urine dipstick:
Protein: 4+
Blood: Negative

A follow-up serum protein electrophoresis (SPEP) assay shows a tall peak in the gamma range. Which of the following would most likely be found on kidney biopsy of this patient?
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