Acute gouty arthritis and rapidly progressive renal failure as manifestation of multiple myeloma: clinical case description
Journal Title: Нирки - Year 2017, Vol 6, Issue 3
Abstract
The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL), rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %), electrophoresis of blood proteins showed a high M-gradient (30.42 %), and a cytochemical study of the bone marrow completely confirmed the diagnosis of multiple myeloma. The presented clinical case is interesting because multiple myeloma clinically debuted with acute gouty arthritis, eclipsing the clinical manifestations of kidney damage and other symptoms.
Authors and Affiliations
O. V. Gudym, T. S. Basovska, L. V. Mykhalska, I. Yu. Golovach
Keywords
Related Articles
- EP ID EP219398
- DOI 10.22141/2307-1257.6.3.2017.109033
- Views 72
- Downloads 0
American Diabetes Association Standards of Medical Care in Diabetes — 2018 Diabetes Care. — 2018 Jan. — 41(S. 1). — https://doi.org/10.2337/dc18-Sint01.
.
Morphological features of kidneys in fetuses and newborns from mothers with subacute infectious-inflammatory process in the abdominal cavity caused by Escherichia coli (experimental study)
Background. In Ukraine, every year the number of women whose pregnancy occurs on the background of chronic infectious diseases increases. Escherichia coli is a frequent causative agent of bacterial infections in women. T...
Enzymaturia as a Marker of Renal Dysfunction in Full-Term Newborns with Perinatal Pathology
Objective — to study the condition of glomerular and tubular functions in full-term newborns with perinatal pathology on the basis of detection of activity of enzymes contained in urine. Materials and methods. We have ex...
Computer-based exam and clinical thinking: a modern assessment of doctor’s knowledge
The current system of medical exam in postgraduate education and continuing professional development is imperfect, it does not take into account the personal level of knowledge and doctor’s physiological state. This lead...
Hypoxia — a Leading Factor of Chronic Kidney Disease Progression
Recent data indicate the involvement of hypoxia in the formation of kidney fibrosis and progression of chronic renal disease. One of the main factors in the chain of damage in the tissue oxygen deficiency is a hypoxia-in...