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Atypical Presentation of Multiple Myeloma as Acute Renal Failure of Unknown Etiology: Two Case Reports
Soumya Saxena1, Prawash K Chowdhary2, Sanjeev A Kale3
1DrNB Trainee, Department of Nephrology, Ramkrishna Care Hospitals, Raipur, Chhattisgarh, India, Corresponding Author.
Abstract:
Multiple myeloma (MM) is a clonal plasma cell proliferative disorder that accounts for 1% of all cancers (Rajkumar). It is a disease of older adults, presenting with anemia, bone pain, and end-organ damage in the form of CRAB features. With increasing awareness regarding this entity and the availability of more-sensitive diagnostic modalities, involvement of younger age-groups with atypical presentations is becoming more common. Newer case series report that nearly 50% of MM cases present initially with renal failure of unknown etiology (Shankar et al.), highlighting the unique role of the nephrologist in the diagnosis of this condition. In these two case reports, we wish to highlight two cases presenting with acute renal failure of unknown etiology, who were subsequently diagnosed to have occult MM with light chain deposition disease (LCDD).
Insights
Multiple myeloma, a cancer of plasma cells, can present as acute renal failure. This study highlights two cases of occult multiple myeloma with light chain deposition disease presenting as unexplained kidney failure.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Multiple myeloma (MM) is a plasma cell cancer, typically affecting older adults.
- MM commonly presents with anemia, bone pain, and CRAB features (Calcium elevation, Renal failure, Anemia, Bone lesions).
- Atypical presentations, including renal failure as an initial symptom, are increasingly recognized, particularly in younger patients.
Purpose of the Study:
- To report two cases of occult multiple myeloma (MM).
- To emphasize the role of nephrologists in diagnosing MM presenting with acute renal failure.
- To highlight light chain deposition disease (LCDD) as a manifestation of occult MM.
Main Methods:
- Case report analysis of two patients with acute renal failure of unknown etiology.
- Diagnostic workup including renal biopsy and laboratory tests to identify underlying causes.
- Review of literature on MM and LCDD presenting with renal impairment.
Main Results:
- Both cases presented with acute renal failure without typical MM symptoms.
- Subsequent diagnosis revealed occult MM with light chain deposition disease (LCDD).
- Renal biopsy findings were crucial in diagnosing LCDD in both patients.
Conclusions:
- Occult multiple myeloma should be considered in patients with unexplained acute renal failure.
- Light chain deposition disease is a significant cause of renal impairment in MM.
- Nephrologists play a vital role in the early diagnosis of MM presenting with renal manifestations.
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