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Renal Disorders in Multiple Myeloma

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    1. Renal Disorders in Multiple Myeloma Hematology Grand Rounds Tom Fong, MD September 9, 2005

    2. Case Report 61 yo BF with no significant PMH except for hyperlipidemia presents with cough/ sinus congestion to her primary MD. She is prescribed an antibiotic (Ketek), and develops nausea, diarrhea, and weakness in the next few days. She returns to her PCP, and is found to have a Cr level of 5.2 (normal 5 mo. earlier).

    3. Case Report PMH: Hyperlipidemia Meds: Estradiol, Ketek Allergies: PCN, cefepime, sulfa Family Hx: Non-contributory Social Hx: Tob 25 pk-yrs, no ETOH ROS: otherwise negative

    4. Case Report Physical exam: Vitals T 37, HR 80, BP 140/70, 96% RA Gen alert, NAD HEENT anicteric, PERRL, O/P clear Lungs CTA CV regular Abd - soft, NT, ND, no HSM Extr no edema

    5. Case Report Labs: WBC 6.8, Hgb 9.5, Plt 176 Na+ 138, K+ 5.0, Cl- 101, HCO3- 25, BUN 39, Cr 6.0, Glucose 87, Ca++ 11.3 LFTs: Protein 8.3, Albumin 5.0, Alk phos 139, Bili 0.4, AST 24, ALT 31 Urine eosinophils: negative

    6. Case Report Labs: SPEP: 0.3, 0.4 gm gamma restricted peaks Serum immunofix: IgG kappa, free kappa LC UPEP: 73.5% gamma restricted peak Urine immunofix: free kappa light chain 24 hour urine protein: 5.085 gms IgA <24, IgG 644, IgM 19 (all low)

    7. Case Report Bone marrow biopsy: 70% cellularity, increased atypical plasma cells comprising 60% of cellularity, c/w multiple myeloma