Renal Impairment in Multiple Myeloma Patients
Added on 2020-01-21
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Multiple myeloma development into End Stage Renal Disease 1Multiple myeloma development into End Stage Renal DiseaseStudent's Name:Instructor's Name:Date:
Multiple myeloma development into End Stage Renal Disease 2Multiple myeloma development into End Stage Renal DiseaseIntroduction: Multiple myeloma is typically a condition which involves slow proliferation of clonal B cells inthe immune system of the body (Katagiri, D et al, 2013). Additionally, there is a production ofmonoclonal proteins and lesions of lytic bones (Katagiri, D et al, 2013). The incidence of renalfailure and even chronic renal illnesses such as end stage renal disease (ESRD) is much commonin patients of multiple myeloma (Katagiri, D et al, 2013).. Studies have indicated that theinduction of renal disorders is likely dependent on the infusion of light chains in most cases.Therefore, renal damage in multiple myeloma is predominantly caused due to the anomalies inthe physicochemical characteristics of light chains (Katagiri, D et al, 2013). Case study and the presentations:Mrs. Morris is a 67 year-old African Australian woman. She presented to the emergency unit dueto failure in kidney functions. The reports of her routine blood tests with reference from herphysician of the primary care indicated anomalies in the studies of renal functions. Sheadditionally complained of non-specific and severe pain in her lower back. Mrs. Morris reportedthe onset of back pain six months prior to her admission at the hospital. The pain was also faintlypresent in the knees and her feet. Thus, Mrs. Morris reported difficulty in functioning ineveryday life. She was diagnosed with degenerative form of osteoarthritis. She had followedseveral traditional methods of healing. Her therapeutic measures included physical therapy alongwith the use of occasional medicines of non inflammatory steroids. However, the pain in thelower back has become severe in the patients due to the ineffectiveness of the medication and
Multiple myeloma development into End Stage Renal Disease 3therapy followed earlier. Thus, Mrs. Morris reported a persistent and severe lower back painalong with pain in the right knee. Mrs. Morris faced difficulty in mobilization and had to use acane for ambulation. Mrs. Morris reported having nausea and vomiting along with severe declinein appetite about one week before her admission into the hospital. The reports from her bloodtests indicated elevated levels of blood urea nitrogen and concentration of creatinine. Theseresults suggest abnormality in kidney functionality. Mrs. Morris additionally experiencedsubjective fevers of low grade during the nights. However, there was no observable loss in bodyweight. Fevers were typically not accompanied by chills or breaks of sweat during the nights.There was also the absence of typical characteristics such as dysuria, reduced output of urine, orthe occurrence of gross hematuria. Current and previous medical history:Her medical history indicated chronic hypertension. She also had mild obesity which contributedto the hypertension. She was being treated for blood pressure with the medications ofhydrochlorothiazide and benazepril along with nabumetone. She admitted having taken over thecounter drugs for symptom control as they have anti-inflammatory drugs for pain in joints. Thevital signs as observed in the emergency were normal. The physical examination of Mrs. Morrisrevealed a mild degree of discomfort along with deep palpitations in the abdomen region. Thepatient did not display an incidence of erythema, warmth around the area of the knee, oreffusion. However, the region around the right knee was tender to palpation. The patient did notshow evidence to neuropathy. The tests conducted on the patient indicated the value of 102mg/dL of blood urea concentration, 14.0 mg/dL of serum creatinine, level of albumin of 3.4g/dL, and a mild elevation in the level of globulin with a value of 3.9 g/dL. The level of
Multiple myeloma development into End Stage Renal Disease 4hemoglobin of the patient was at 12.9 g/dL and hematocrit level was at 36% where rouleaux wasabsent in the smear. The patient was admitted for abnormal kidney functionality values. Thecollected urine sample over a span of 24 hours was tested and revealed 2.6 g of protein alongwith 1.1 g of creatinine. The etiology that preceded the kidney failure was quite unclear at thetime of admission due to which the patient was advised to undergo renal biopsy. The biopsy wasstudied under light microscopic technique which revealed that there was a presence of large castsof hyaline which were mononucleate. Additionally, giant cells containing multiple nuclei werealso observed. The kappa staining procedure indicated positive staining of casts of tubularconformation. The findings of the biopsy reports were congruent with the results of nephropathyof myeloma casts. Amyloid was absent on the biopsy. The electrophoresis of the serum proteinsample from the showed the presence of a monoclonal spike in the region of gamma along with afree band of kappa in the gamma region in an immunoelectrophoresis test. The electrophoresis ofurine sample of the patient showed a prominent M spike of 62.1 mg/dL. Multiple lesions of theosteosclerotic nature were observed in the skull in the radiographic survey of the skeletal system.Various scattered lesions lytic lesions were present in the right humerus in the proximal position,the scapula on the right, and bilateral femurs on the distal side. The hematological reports of thepatient indicated the presence of hypercellular organization and diffuse plasmacytosis whichwere diffuse in nature. Flow cytometry tests of the biopsy confirmed a population of monoclonalplasma cells with restriction of kappa cells along with negative ancillary stains. Pathogenesis of multiple myeloma:The patient was diagnosed with multiple myeloma of the free light chain containing nephropathyof the casts. Multiple myeloma is a proliferation of plasma cells in a malignant manner (Kuo, VC
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