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首页> 外文期刊>Journal of Clinical Medicine Research >Immunoglobulin D Multiple Myeloma With Rapidly Progressing Renal Failure
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Immunoglobulin D Multiple Myeloma With Rapidly Progressing Renal Failure

机译：免疫球蛋白D多发性骨髓瘤伴快速进展的肾衰竭

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Immunoglobulin D (IgD) multiple myeloma (MM) is a very rare form of myeloma affecting less than 2% of all myeloma patients. It has a multiorgan involvement with renal failure being the key feature. We present here a case of IgD MM in a 62-year-old white male, smoker with past medical history of hypertension, who presented to emergency department with complaints of lower abdominal pain, constipation and decreased urination. Physical exam was unremarkable. Laboratory investigation showed S.Cr 5.99 mg/dL, hemoglobin 8.7 g/dL and corrected S.Ca 10.6 mg/dL. Urine dipstick showed 100 protein and TP/Cr ratio was 23. Serology was positive for serum free lambda chain level of 8,947.6 mg/L as well with free κ/λ ratio < 0.01. The results of serum and urine electrophoresis and immunofixation were also supportive of diagnosis of IgD MM. IgD level was remarkably elevated (27,300 mg/L) too. CT scan of abdomen/pelvis was negative for obstructive uropathy. Skeletal survey showed a solitary lytic lesion in the iliac crest. His kidney function deteriorated next day requiring hemodialysis. The bone marrow biopsy was positive for plasma cell hypercellularity (70-80%) and flow cytometry showed 8% monoclonal IgD lambda plasma cells. The patient was started on bortezomib and dexamethasone and he underwent bone marrow transplant 6 months later. He is doing well hematologically now but he remains dialysis-dependent. IgD MM is a very rare disease affecting younger population with poor prognosis; patients often end up on hemodialysis despite better control of the hematological component.J Clin Med Res. 2015;7(8):653-655doi: http://dx.doi.org/10.14740/jocmr2210w
机译：免疫球蛋白D（IgD）多发性骨髓瘤（MM）是一种非常罕见的骨髓瘤形式，仅影响不到2％的所有骨髓瘤患者。它具有多器官受累，肾衰竭是关键特征。我们在这里介绍了一例IgD MM病例，该患者是一名62岁的白人男性，吸烟者有高血压病史，他因出现下腹部疼痛，便秘和排尿减少而向急诊科就诊。身体检查不明显。实验室调查显示S.Cr为5.99 mg / dL，血红蛋白为8.7 g / dL，校正的S.Ca为10.6 mg / dL。尿液试纸显示100种蛋白质，TP / Cr比值为23。血清学检测结果为血清游离λ链水平为8,947.6 mg / L，游离κ/λ比<0.01。血清和尿液电泳和免疫固定的结果也支持IgD MM的诊断。 IgD水平也显着升高（27,300 mg / L）。腹部/骨盆的CT扫描显示梗阻性尿毒症阴性。骨骼检查显示在c中有一个孤立的溶解性病变。第二天他的肾功能恶化，需要血液透析。骨髓活检显示浆细胞高细胞阳性（70-80％），流式细胞仪显示8％的单克隆IgDλ浆细胞。该患者开始接受硼替佐米和地塞米松治疗，六个月后接受了骨髓移植。他现在的血液学状况良好，但仍依赖于透析。 IgD MM是一种非常罕见的疾病，会影响到预后不良的年轻人群。尽管血液成分得到了更好的控制，但患者通常仍需进行血液透析。 2015; 7（8）：653-655doi：http://dx.doi.org/10.14740/jocmr2210w

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