Acute kidney injury in a patient with polyarteritis nodosa and multiple myeloma

Area of Science:

• Nephrology
• Hematology
• Immunology

Background:

• Polyarteritis nodosa (PAN) is a systemic vasculitis.
• Multiple myeloma (MM) is a plasma cell malignancy.
• Co-occurrence of PAN and MM is rare.

Observation:

• A Japanese male patient presented with symptoms of PAN.
• Diagnosis confirmed PAN with coexisting IgG kappa paraprotein and bone marrow findings suggestive of MM.
• Initial treatment with prednisolone (PSL) and plasmapheresis did not prevent progressive renal dysfunction.

Findings:

• The patient required hemodialysis due to worsening renal failure.
• Despite aggressive management, the patient succumbed to pneumonia 12 months post-admission.
• Renal failure emerged as a critical prognostic factor.

Implications:

• This case underscores the challenges in managing patients with concurrent PAN and MM.
• Aggressive immunosuppression and renal support may be necessary.
• Early recognition of renal involvement is crucial for patient outcomes.