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Kidney Week

Abstract: TH-PO136

Bilateral Renal Infarction: An Uncommon Presentation of Multiple Myeloma

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Patel, Jayesh B., University of Iowa Hospitals and Clinics, Iowa city, Iowa, United States
  • Oo, Swe Zin Mar Win Htut, University of Iowa Hospitals and Clinics, Iowa city, Iowa, United States
  • Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa city, Iowa, United States
  • Fraer, Mony, University of Iowa Hospitals and Clinics, Iowa city, Iowa, United States
Introduction

We report on a case of bilateral renal infarction from disseminated intravascular coagulation, secondary to a previously undiagnosed multiple myeloma. This cause of acute renal infarction is uncommon and may have a misleading presentation, leading to diagnostic delays/misdiagnosis, reason for us highlighting it here.

Case Description

A 70-year-old male with coronary disease, hypertension, repaired abdominal aortic aneurysm, presented with acute onset severe abdominal pain, nausea and a 25 lbs weight loss (in 6 months). Blood pressure was 185/96 mm Hg. He had abdominal tenderness. Labs showed hyponatremia (normal plasma osmolality) and creatinine was 1.43. CBC showed leukocytosis, anemia and thrombocytopenia. Peripheral smear showed Rouleaux formation and plasma cells (plasma cell count was 1239/mm3). Also, there was an elevated LDH, D-Dimer, and low fibrinogen, haptoglobin. He had an elevated bilirubin, alkaline phosphatase and AST with normal ALT. Prothrombin time and INR were elevated. A CT scan showed wedge-shaped opacifications within the right kidney and the left renal cortex without thrombi. Procalcitonin was normal and factor 5 Leiden mutation was absent. A 2D-echo was negative for any valvular disease. EKG showed sinus rhythm. With concerns for multiple myeloma (age, creatinine, rouleaux formation, increased plasma cells), we observed a monoclonal protein in SPEP. SIFE showed monoclonal IgG-Lambda protein. Kappa/Lambda free Light chain ratio was 0.01. Bone marrow biopsy revealed 20% plasma cells. FISH showed an IgH/MAF rearrangement (seen in plasma cell disorders). Carfilzomib, cyclophosphamide and dexamethasone as well as anticoagulation were initiated. Partial remission was achieved within two cycles of chemotherapy. Creatinine came down to 1.0.

Discussion

Multiple myeloma is a hematological malignancy that similar to other malignancies, can lead to disseminated intravascular coagulation and infarction at unusual places. We want to bring to the clinicians’ attention this relatively uncommon causes of renal infarction.

CT scan of Abdomen showing bilateral renal infarction