Adachi Gen, Mouri Naoto, Ohta Ryuichi, Sano Chiak
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2021 Oct 29;13(10):e19135. doi: 10.7759/cureus.19135. eCollection 2021 Oct.
Cast nephropathy is rare kidney disease with slow progression. It is associated with multiple myeloma (MM). In this study, we report a case of cast nephropathy in an 86-year-old woman who was previously independent in her activities of daily living (ADLs). However, she was found to have severe renal impairment after vomiting and a decrease in her ADLs. Blood and urine tests revealed the renal disorder. The patient was immediately treated with hemodiafiltration. IgG, IgA, and IgM levels were decreased by immunoelectrophoresis. A kidney biopsy showed crystals and periodic acid-Schiff stain (PAS)-negative urinary casts in the tubules. Bence Jones protein-lambda type M protein was detected in the urine. The patient was diagnosed with cast nephropathy due to MM. Hemodialysis was continued. The patient's family and the patient did not wish to initiate chemotherapy. The decision was made to follow the patient's progress. In this case, a patient who was originally independent in her ADLs developed severe renal failure with an acute course. This case suggests the importance of differentiating MM based on renal failure, even if the presentation is not typical, as elderly patients may have an atypical presentation of the disease, which can avoid invasive procedures such as renal biopsy.
管型肾病是一种进展缓慢的罕见肾脏疾病。它与多发性骨髓瘤（MM）相关。在本研究中，我们报告了一例86岁女性的管型肾病病例，该患者此前日常生活活动（ADL）能够自理。然而，在出现呕吐及ADL能力下降后，发现她有严重的肾功能损害。血液和尿液检查揭示了肾脏疾病。患者立即接受血液透析滤过治疗。免疫电泳显示IgG、IgA和IgM水平降低。肾脏活检显示肾小管中有结晶和过碘酸希夫染色（PAS）阴性的尿沉渣。尿液中检测到本-周蛋白λ型M蛋白。该患者被诊断为MM所致的管型肾病。继续进行血液透析。患者家属和患者不希望开始化疗。决定对患者的病情进展进行随访。在该病例中，一名原本ADL能够自理的患者出现了急性病程的严重肾衰竭。该病例表明，即使临床表现不典型，基于肾衰竭鉴别MM也很重要，因为老年患者可能有该疾病的非典型表现，这可以避免诸如肾活检等侵入性操作。
