Abu Salman Liann, Reisinger Nathaniel
Division of Renal, Electrolytes and Hypertension, University of Pennsylvania Philadelphia, PA USA.
POCUS J. 2022 Feb 1;7(Kidney):24-26. doi: 10.24908/pocus.v7iKidney.15342. eCollection 2022.
A 63-year-old man with past history of multiple myeloma recently started on a regimen of daratumumab, carfilzomib, and dexamethasone was referred to our emergency department for a rapidly rising serum creatinine as high as 10 mg/dL. He complained of fatigue, nausea, and poor appetite. Exam revealed hypertension, but no edema or rales. Labs were consistent with AKI without hypercalcemia or evidence of hemolysis or tumor lysis. Urinalysis and urine sediment were bland without proteinuria, hematuria, or pyuria. Initial concern was for hypovolemia or myeloma cast nephropathy. POCUS revealed no overt evidence of volume overload or depletion, instead revealing bilateral hydronephrosis. Bilateral percutaneous nephrostomies were placed with resolution of the AKI. Ultimately, referral imaging revealed interval progression of bulky retroperitoneal extramedullary plasmacytomas compressing the ureters bilaterally related to the underlying multiple myeloma.
一名63岁有多发性骨髓瘤病史的男性，最近开始使用达雷妥尤单抗、卡非佐米和地塞米松治疗，因血清肌酐迅速升至高达10mg/dL而被转诊至我院急诊科。他主诉疲劳、恶心和食欲不佳。体格检查发现高血压，但无水肿或啰音。实验室检查结果符合急性肾损伤，无高钙血症，也无溶血或肿瘤溶解的证据。尿液分析和尿沉渣检查均正常，无蛋白尿、血尿或脓尿。最初考虑为血容量不足或骨髓瘤管型肾病。床旁超声检查未发现明显的容量超负荷或血容量不足证据，反而发现双侧肾积水。双侧经皮肾造瘘术后急性肾损伤得到缓解。最终，转诊影像学检查显示，与潜在的多发性骨髓瘤相关的双侧输尿管受压，腹膜后巨大髓外浆细胞瘤有进展。
