Myeloma Cast Nephropathy Manifesting only as Unexplained Acute Renal Failure

摘要

Multiple Myeloma (MM) is characterised by clonal B cell proliferation affecting elderly age group and involving various organ systemsnamely haematological, renal and skeletal system. Kidney may be affected in 50% of cases of MM. Though Chronic Kidney Disease(CKD) is usually seen in MM, unusual presentations have been documented. The present case is of a 50-year-old female with complainsof breathlessness and vague generalised symptoms. Routine tests showed blood urea level of 90 mg/dL and serum creatinine of8.3 mg/dL. Further investigations revealed 24 hour protein level 48.5 gm/day, Erythrocyte Sedimentation Rate (ESR)-126 mm/1 st hour,cast nephropathy in renal biopsy. Immunohistochemical (IHC) study on renal biopsy revealed kappa light chain deposits in tubules,raised kappa light chains (3280.00 mg/L) in serum Free Light Chain (FLC) assay and MM in bone marrow aspiration and biopsy study.So, MM should be considered in differential diagnosis in elderly patients presenting with acute severe renal failure.