ultiple myeloma is a plasma cell dyscrasia that can have various clinical presentations. Signs and symptoms often refl ect plasma cell infi ltration into organs but can be subtle. We report a case of a woman who presented with nonoliguric acute kidney injury as the initial manifestation of multiple myeloma. CASE PRESENTATION A 68-year-old African American woman presented to the emergency department after routine blood work with her primary care physician revealed abnormal renal function studies. Six months prior to admission, she began to have nonspecifi c pain in her back, knees, and feet. Degenerative osteoarthritis was diagnosed, and she was treated with conservative measures including physical therapy and occasional use of nonsteroidal antiinfl ammatory medicines. However, the pain persisted, especially in her right knee, and she had to ambulate with a cane. One week prior to admission, the patient developed abdominal cramps with nausea, vomiting, and decreased appetite. She saw her physician and had blood work done, which showed marked elevation of blood urea nitrogen and creatinine concentrations. She reported subjective low-grade fevers, but denied any weight loss, chills, or night sweats. She also denied any dysuria, gross hematuria, or any decrease in urine output. Her past medical history included longstanding hypertension and mild obesity. Her home medications included benazepril and hydrochlorothiazide for blood pressure and nabumetone and other over-the-counter antiinfl ammatory medications for joint pain. Th e patient also tried various health food supplements, including bromelain, ginger root, and CuraMed antioxidant, about 1 month prior to admission to help with her pain. She denied any smoking, drinking, or illicit drug use and was a retired schoolteacher. Th e patient was comfortable in the emergency department with normal vital signs, and physical examination revealed some mild discomfort to deep palpation in her abdomen. Th ere was no erythema, eff usion, or warmth around her knees, but the patient did have mild tenderness to palpation around her right knee. Th ere was no evidence of
