Goranov S, Hristova I, Pencheva K
Clinic of Haematology, University of Medicine, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 1994;36(2):63-6.
We report on a 65-year-old female patient with an A-kappa multiple myeloma diagnosed on the grounds of bone pain, anemia and extremely elevated erythrocyte sedimentation rate (ESR). Eight years prior to admission to the Clinic of Haematology the patient started to excrete a considerable amount of urine (4-6 liters per 24 hrs) with low specific gravity and to experience hardly controllable thirst. The disorder was specified in a specialised endocrinologic clinic as diabetes inspidus with ambiguous aetiology. The administered treatment with adiuretin had a small effect. A course of cyclophosphamide and glucocorticosteroids was started after myeloma was diagnosed--this had a considerable effect on the polyuria and polydipsia; the specific gravity of the urine increased. This effect, as well as the proven light chain proteinuria in the patient, leads to the interpretation of the early complaints of the patient as onset of the underlying disease in the form of nephrogenic diabetes insipidus--a rare light chain tubular syndrome.
我们报告了一名65岁的女性患者，因骨痛、贫血和红细胞沉降率（ESR）极度升高被诊断为A-κ型多发性骨髓瘤。在入住血液科诊所的八年前，患者开始排出大量尿液（每24小时4-6升），尿比重低，并出现难以控制的口渴。该病症在一家专门的内分泌诊所被明确为病因不明的尿崩症。使用垂体后叶素进行治疗效果甚微。在诊断出骨髓瘤后，开始使用环磷酰胺和糖皮质激素进行治疗——这对多尿和烦渴产生了显著效果；尿比重增加。这种效果，以及患者已证实的轻链蛋白尿，导致将患者早期的症状解释为潜在疾病以肾性尿崩症（一种罕见的轻链肾小管综合征）的形式发作。
