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Multiple myeloma presenting as proliferative (crescentic) glomerulonephritis
1Dept of Nephrology, Hinduja National Hospital, Mahim, Bombay.
Insights
Rapidly progressive glomerulonephritis with crescent formation is a rare multiple myeloma manifestation. Early diagnosis is crucial for managing this aggressive kidney disease, though outcomes remain challenging.
Area of Science:
- Nephrology
- Oncology
- Pathology
Background:
- Multiple myeloma can present with rare renal manifestations.
- Rapidly progressive glomerulonephritis (RPGN) with crescent formation is an uncommon presentation.
Observation:
- A 58-year-old female presented with hematuria, weight loss, and fever.
- Renal biopsy confirmed RPGN, leading to hemodialysis for uremic symptoms.
Findings:
- Multiple myeloma was diagnosed six months later, following the onset of persistent bone pain.
- Serum protein electrophoresis and bone marrow biopsy confirmed the diagnosis.
Implications:
- This case highlights the importance of considering multiple myeloma in RPGN presentations.
- Timely diagnosis and treatment are critical for managing myeloma-associated kidney disease, despite poor prognoses.
Abstract:
Glomerular extracapillary cellular proliferation with crescent formation initially presenting as rapidly progressive glomerulonephritis is a rare clinical manifestation of multiple myeloma. We report here a case of a 58 year old female who initially presented with haematuria, loss of weight and appetite and history of febrile episodes and was diagnosed following renal biopsy as rapidly progressive glomerulonephritis. Haemodialysis was carried out a month later because of uremic symptoms and maintained with monitoring of serum, calcium, phosphate, alkaline phosphatase, albumin and iPTH levels. After 6 months, she complained of bone pains over anterior chest wall which persisted even with low calcium haemodialysis. Serum protein electrophoresis and bone marrow aspiration revealed multiple myeloma. On starting chemotherapy, bone pain subsided but the patient expired within 15 days of therapy.