Multiple Myeloma Presenting as Acute Renal Failure

Abstract

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

From Toxic Ingestion to Cancer: Dramatic Acidosis as a Myeloma-Defining Event

“…As such, it must be interpreted with caution [ 12 , 13 ]. Multiple myeloma is known to cause a wide array of pathologies in the kidney and can present in numerous ways, including acute kidney failure and altered mental status [ 14 - 16 ]. AGMA can be present secondary to kidney failure, however, a significant increase in the osmolar gap is not commonly seen [ 3 , 16 ], making this an unusually striking example.…”

Multiple Myeloma Mimicking a Small Vessel Vasculitis Presentation

“…e etiology of each of the mechanisms involved in myeloma's kidney disease is worth mentioning: Renal insufficiency is present in at least half of the myeloma patients and is associated with increased mortality. e three forms of renal injury (cast nephropathy, monoclonal immunoglobulin deposition disease, and light chain amyloidosis) can coexist, but cast nephropathy is the most prevalent [2,3]. e finding of a blue finger in association with glomerular findings in the absence of anemia, hypercalcemia, and monoclonal gammopathy in the serum protein electrophoresis made systemic vasculitis as the first clinical possibility.…”

“…e initial laboratory tests were hemoglobin 12 (gr/dL), hematocrit 37%, leukocytes 10,200 (mm 3 ) [3], neutrophils 76%, platelets 564,000 (mm 3 ), creatinine 1.64 (mg/dL), BUN 25 (mg/dL), glycaemia 121 (mg/dL), PT 14.7, INR 1.03, PTT 29/28.5, ESR 2 mm/h, and CRP 1.2 mg/dL. Urine test: proteinuria +++ estimated in 300 mg/dL, RBC 6/hpf, WBC 4/hpf, and RBC casts: present.…”

“…e presentation of a blue digit as a manifestation of multiple myeloma is uncommon. Usually vasculitis is the underlying disease [3].…”

Unconventional Presentation of Multiple Myeloma: A Series of 4 Cases

“…Multiple myeloma is a clonal proliferation of plasma cells that occurs in older adults, median age at diagnosis is about 70 years [5,6]. Presenting symptoms are variable, including fatigue, generalized weakness, weight loss, and bone pain, and there is often evidence of some organ damage [7]. The diagnosis of multiple myeloma depends on a concurrence of features, and several different diagnostic criteria as suggested by the International Myeloma working group [8].…”