Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone
Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year...
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| Format: | Article |
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Wiley
2014-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2014/940171 |
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| author | Bhanu K. Patibandla Akshita Narra Ahmad A. Alwassia Anthony Bartley Gurprataap S. Sandhu James Rooney Robert M. Black |
| author_facet | Bhanu K. Patibandla Akshita Narra Ahmad A. Alwassia Anthony Bartley Gurprataap S. Sandhu James Rooney Robert M. Black |
| author_sort | Bhanu K. Patibandla |
| collection | DOAJ |
| description | Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count—18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium—6.7 mEq/L, bicarbonate—15 mEq/L, blood urea nitrogen—62 mg/dL, SCr—5.6 mg/dL (baseline: 1.10), and corrected calcium—11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen. |
| format | Article |
| id | doaj-art-d21506c9c29f4383a7765efb1630c118 |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
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| series | Case Reports in Nephrology |
| spelling | doaj-art-d21506c9c29f4383a7765efb1630c1182025-02-03T05:46:14ZengWileyCase Reports in Nephrology2090-66412090-665X2014-01-01201410.1155/2014/940171940171Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and DexamethasoneBhanu K. Patibandla0Akshita Narra1Ahmad A. Alwassia2Anthony Bartley3Gurprataap S. Sandhu4James Rooney5Robert M. Black6Department of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USADepartment of Medicine, University of Connecticut, Farmington, CT 06030, USADepartment of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USADepartment of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USADepartment of Medicine, University of Pittsburgh Medical Centre, 200 Lothrop Street, Pittsburgh, PA 15206, USADepartment of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USADepartment of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USARenal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count—18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium—6.7 mEq/L, bicarbonate—15 mEq/L, blood urea nitrogen—62 mg/dL, SCr—5.6 mg/dL (baseline: 1.10), and corrected calcium—11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen.http://dx.doi.org/10.1155/2014/940171 |
| spellingShingle | Bhanu K. Patibandla Akshita Narra Ahmad A. Alwassia Anthony Bartley Gurprataap S. Sandhu James Rooney Robert M. Black Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone Case Reports in Nephrology |
| title | Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone |
| title_full | Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone |
| title_fullStr | Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone |
| title_full_unstemmed | Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone |
| title_short | Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone |
| title_sort | case report on renal failure reversal in lambda chain multiple myeloma with bortezomib and dexamethasone |
| url | http://dx.doi.org/10.1155/2014/940171 |
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