Abstract

LANCA, Alic; SANTOS, Paulo  and  FERRER, Francisco. 72-year-old man with acute kidney injury, hypercalcemia and metastatic prostate câncer. Port J Nephrol Hypert [online]. 2017, vol.31, n.4, pp.310-314. ISSN 0872-0169.

Paraproteinemias are characterized by the abnormal expansion of a plasma cell clone with overproduction of a monoclonal (M) immunoglobulin. In rare cases (1%) two distinct M proteins can be identified (biclonal gammopathy). Renal manifestations are frequent and can present with several histological patterns. Prognosis and treatment are similar to monoclonal gammopathies varying according to extent of disease and response to therapy. We report a case of a 72-year-old man with a prior history of hypertension, dyslipidemia, and prostate cancer with bone metastasis under treatment with leuproline, cyproterone, and nonsteroidal anti-inflammatory drugs who was found to have anemia, acute kidney injury, and hypercalcemia. After clinical evaluation and workup, a biclonal multiple myeloma (IgG kappa and IgA lambda) and a cast nephropathy were diagnosed. The patient was started on renal replacement therapy and on CyBorDex treatment cycle protocol for two years with remission of multiple myeloma but without renal function recovery. During this period, there was no prostate cancer progression. This case report alerts us to the rarity of a biclonal multiple myeloma especially in a patient with advanced prostate cancer but also to the fact that not all osteolytic lesions are secondary lesions

Keywords : acute kidney injury; biclonal gammopathy; cast nephropathy; hypercalcemia; multiple myeloma; prostate câncer.

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