Multiple Myeloma in a Young Adult with Renal Involvement

Abstract

Ms. S.W, 34, with no medical history, was admitted for investigation of advanced renal failure. On admission, she was asthenic and complained of headache and gastric pain. On examination, she weighed 62 kg, she had normal blood pressure, correct hydration, and no abnormalities on cardiopulmonary auscultations. she had a preserved diuresis (1 L). The urine dipstick showed proteinuria: + and no hematuria.At biological assessment, she had serum creatinine at 707 μmol/L, normochromic normocytic anemia at 5.2 g/ dL with direct positive IgG-type Coombs test, serum calcium at 2.8 mmol/L and LDH level at 488 mmol/L. At protein electrophoresis: monoclonal peak in gamma position. Twenty-four-hour proteinuria dosage was 7 g/24 H, in contrast with low proteinuria with labstix. the blood ionogram showed a natremia at 140 mmol/L, a kalemia at 5.6 mmol/L and a chloremia at 110 mmol/L. At serum immunoelectrophoretic profile, the presence of a monoclonal gammopathy type Ig G Lambda (Figure 1). The serum-free light chains (FLC) ratio kappa/lambda was equal to 0.03. Urine immunoelectrophoresis showed positive urinary monoclonal protein (free lambda chain); The ratio of kappa to lambda chains in urine was 0.017. On the myelogram: 32% plasmacytosis. On the kidney ultrasound, she had two well-differentiated normalized kidneys. She had a renal biopsy, which showed an aspect of myelomatous tubulopathy (Figure 2). The spinal MRI was without abnormalities. CRAB criteria 6 in our patient, involved hypercalcemia, renal failure, and anemia but no bone damage. The retained diagnosis in our patient was: MM with IgG Lambda class III of Salmon and Durie. 7 R-ISS prognostic factors 8 included respectively serum