Gastelum Zachary N, Biggs Diana M, Scott Aaron
University of Arizona College of Medicine-Tucson.
Hematology and Oncology, University of Arizona Cancer Center.
Cureus. 2017 Sep 20;9(9):e1703. doi: 10.7759/cureus.1703.
This case report describes a 54-year-old, asymptomatic man who presented with hyperkalemia on routine lab testing who was later found to have acute renal failure, unresponsive to fluid resuscitation, with minimal improvement after hemodialysis. After a comprehensive evaluation ruled out common causes of acute renal failure, the patient underwent testing with a bone survey, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunoelectrophoresis for suspected plasma cell dyscrasia and received plasmapheresis for hyperviscosity syndrome and nephrotoxicity, which resulted in improved renal function. Lab results showed monoclonal gammopathy, elevated serum free light chains, and Bence Jones protein in the urine with a follow-up bone marrow biopsy indicating plasma cell dyscrasia. The patient received a diagnosis of multiple myeloma (MM) and was started on chemotherapy and immunosuppression. In patients presenting with acute renal failure with an evaluation ruling out prerenal and postrenal causes, multiple myeloma should be considered.
本病例报告描述了一名54岁无症状男性，其在常规实验室检查时发现高钾血症，随后被诊断为急性肾衰竭，对液体复苏无反应，血液透析后改善甚微。在全面评估排除急性肾衰竭的常见病因后，患者接受了骨扫描、尿蛋白电泳（UPEP）、血清蛋白电泳（SPEP）以及免疫电泳检查，以排查疑似浆细胞异常增生症，同时因高黏滞综合征和肾毒性接受了血浆置换治疗，肾功能由此得到改善。实验室检查结果显示存在单克隆丙种球蛋白病、血清游离轻链升高以及尿本-周蛋白，后续骨髓活检提示浆细胞异常增生症。该患者被诊断为多发性骨髓瘤（MM），并开始接受化疗和免疫抑制治疗。对于出现急性肾衰竭且评估排除肾前性和肾后性病因的患者，应考虑多发性骨髓瘤。
