Introduction:
MULTIPLE MYELOMA (MM) IS A MALIGNANT PROLIFERATIVE TUMOR OF PLASMA CELLS [1]. [2] RENAL IMPAIRMENT (RI) IS A COMMON COMPLICATION OF MULTIPLE MYELOMA (MM). AROUND 50% OF PATIENTS WITH MULTIPLE MYELOMA HAVE RENAL IMPAIRMENT AT PRESENTATION, AND UP TO 5% REQUIRE DIALYSIS TREATMENT. PATIENTS WITH MORE SEVERE RENAL IMPAIRMENT, IN PARTICULAR THOSE WITH A REQUIREMENT FOR DIALYSIS, ARE LESS LIKELY TO RECOVER RENAL FUNCTION. SURVIVAL OF PATIENTS WITH MYELOMA TREATED WITH DIALYSIS IS STILL SHORT [3]. RAPID DIAGNOSIS AND PROMPT INSTITUTION OF ANTI-MYELOMA THERAPY IS AN IMPORTANT DETERMINANT OF RENAL FUNCTION RECOVERY.[2]
Methods:
CASE REPORT
52-YEAR-OLD MALE, PRESENTED WITH A TWO MONTH HISTORY OF BILATERAL PROGRESSIVE PITTING PEDAL EDEMA AND HEMATURIA.
ON PRESENTATION:
DYSPNEIC
BILATERAL PITTING PEDAL EDEMA
BLOOD PRESSURE WAS 170/100 MMHG
CHEST: BILATERAL BASAL CREPTS
ON INVESTIGATION FOUND TO HAVE PROTEINURIA, HEMATURIA AND RAPIDLY PROGRESSIVE RENAL FAILURE. DETAILS OF WORK UP ARE OUTLINED IN TABLE 1. THREE DOSES OF METHYLPREDNISOLONE WAS GIVEN IN VIEW OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS. HEMODIALYSIS WAS INITIATED IN VIEW OLIGURIA AND METABOLIC ACIDOSIS. TOTAL 14 SESSION OF DIALYSIS WAS DONE. THEN PATIENT WAS UNDERWENT RENAL BIOPSY WHICH SHOWED EVIDENCE OF AMYLOIDOSIS. (DETAILS DEPICTED IN TABLE 1). BUT NO EVIDENCE OF AMYLOIDOSIS WAS FOUND IN ABDOMINAL FAT PAD. BONE MARROW BIOSPY WAS DONE WHICH SHOWED 15% PLASMA CELLS. NO LYTIC LESION WAS FOUND IN PET CT. PATIENT RECIEVED D-VTD PROTOCOL. PATIENT WAS ON MAINTAINENCE HEMODIALYSIS (3/7) FOR 1 MONTH. AFTER 1 MONTH OF CHEMOTHERAPY RENAL FUNCTIONS WERE GRADUALY IMPROVING WITH GOOD URINE OUTPUT. (TABLE 2A/B). NOW PATIENT WAS OFF THE HEMODIALYSIS FOR PAST 4 WEEKS.
TABLE 1 LAB INVESTIGATION
TABLE 2 A PRE CHEMOTHERAPY
TABLE 2 B.POST CHEMOTHERAPY
Results:
DISCUSSION
PATIENT PRESENT AS RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS AND UNDERWENT HEMODIALYSIS. DIAGNOSED TO HAVE AMYLOIDOSIS ON RENAL BIOPSY WHICH INITIATLLY MISGUIDED THE MANAGEMENT. LATER ON, FOUND TO HAVE MULTIPLE MYELOMA ON BONE MARROW BIOPSY. PROMPTLY INITIATED ON D – VTD PROTOCOL WHICH LEAD TO DIALYSIS FREE PERIOD. QUALITY OF LIFE OF THE PATIENT WAS IMPROVED.
Conclusions:
CONCLUSION
THIS CASE EMPHASIZED THAT PROMPT DIAGNOSIS OF MULTIPLE MYELOMA AND MANAGEMENT INCLUDING HEMODIALYSIS AND CHEMOTHERAPY CAN LEAD TO FAVOURABLE OUTCOME IN PATENT
REFERENCE
1 Kumar SK Multiple myeloma Nat Rev Dis Primers (2017) 3:17046. doi: 10.1038/nrdp.2017.46
2 Current Trends of Renal Impairment in Multiple Myeloma Cockwell Kidney Dis 2015;1:241–257 DOI: 10.1159/000442511
3 Survival of myeloma patients treated with dialysis G Martín Reyes Nefrologia 2003;23(2):131-6
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.