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A large part of patients with multiple myeloma present systemic manifestations related to the infiltration of plasma cells in different organs associated with the damage caused by excess light chains. Kidney disease is a common manifestation in this entity, it occurs in half of the cases and darkens the prognosis. It has different presentation mechanisms. In this case we highlight the tubular lesion KIDNEY OF MYELOMA.
CLINICAL CASE 47 year old woman. Secretary. Condition manifested by fatigue and hyporexia to which are added myalgias, arthralgias predominantly in the evening, refractory to the use of over-the-counter symptomatic medications. Two weeks later, edema was added to the lower limbs with a progressive increase during the day. Progressive edema, without changes in general condition, one month after its onset, which is why he attended evaluation. Externally assessed, describing edema in slopes, generalized paleness. Request laboratory studies. Upon finding biochemistry compatible with kidney damage, they requested complementary studies and performed a kidney biopsy and proposed extracorporeal renal therapy. She decides to continue management in our hospital as she is entitled to the institutional service. On examination: highlights: oriented, pale, dehydrated, BP: 138/84, HR: 94, RR: 22, Temp: 36.3, Weight: 62Kg, Height: 1.60m; no orthopnea, precordium without aggregates; peristalsis present, mild diffuse abdominal pain, no rebound, no megaliae palpable; diuresis present, positive godette up to the proximal third of both legs, cold, not painful, symmetrical, thus distal capillary refill.
Biochemical tests in which grade 2 anemia, AKIN III acute kidney injury due to CKD-EPI and creatinine, as well as hypercalcemia (three data from CRAB) stand out; In addition to this: elevated Beta 2 microglobulin, hyperuricemia; in urine: proteinuria without bacteriuria. Normal immunological.Kidney biopsy: 11 glomeruli. Direct immunofluorescence for IgA, IgG, IgM, C3 and C1q: Negative. Albumin + in MBT; fibrinogen: ++ in the contour of the glomerular capillaries; Kappa: +++ in the periphery of intratubular cylinders, Lambda; NEG.
The bone marrow aspirate documents 28% infiltration by type 1 and 2 plasmablasts. Criteria to determine the diagnosis of IgA IIIB multiple myeloma
Renal failure is the initial manifestation of multiple myeloma in up to 50% of patients; however, in the case of de novo renal failure in a female patient in her fifth decade, renal biopsy is indicated for the histopathological diagnosis of the hematuria proteinuria syndrome in the context of kidney failure; In this case, the biopsy supported the diagnosis of multiple myeloma manifested by KIDNEY OF MYELOMA, a rare entity in his age group, and also ruled out other conditions, which modified the prognosis and definitive treatment.