表现为急性肾小管间质性肾炎的骨髓瘤肾损害

Multiple myeloma presented as acute tubulointerstitial nephritis

中年男性患者,临床表现为腰部疼痛,椎体多发骨折,大量蛋白尿伴血清肌酐升高,无低蛋白血症和高脂血症,伴有高钙血症和高尿酸血症,免疫固定电泳发现单克隆λ轻链,骨髓穿刺明确多发性骨髓瘤,肾活检组织学为急性间质性肾炎,未见典型骨髓瘤管型,结合临床,考虑骨髓瘤相关肾损害。

A 51-year-old man presented with lumbar pain,and was diagnosed as vertebral fracture. Laboratory examination revealed heavy proteinuria without hypoproteinemia and hyperlipidemia,accompanied by hypercalcemia and hyperuricemia. Monoclonal λ freelight chain was identified by immunofixation electrophoresis. Multiple myeloma was comfirmed with bone marrow examination.A renal biopsy showed acute interstitial nephritis without typical myeloma casts.The final diagnosis was acute tubulointerstitial nephritis associated with multiple myeloma.