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Multiple myeloma is a malignant disease that results in the proliferation of a single plasma cell clone. The clinical manifestations are anemia, bone pain, bone fractures, hypercalcemia, hypergammaglobulinemia, increased erythrocyte sedimentation rate, rouleaux formation on the peripheral blood smear and rarely increased serum viscosity. Rarely cas...
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Context 1
... patient developed intrinsic acute renal failure secondary to intrarenal tubular obstructions with myeloma proteins and required temporary support by hemodialysis. In the patient's renal biopsy the renal tubules were filled with eosinophilic fractured casts (Figure 1) whereas there were multinucleated histocytic giant cells around renal tubules (Figure 2). Circulating free light chains (FLC) could lead to acute renal injury due to intratubular precipitation, and initial treatment can be achieved by adequate hydration and removal of the FLC with different apheresis techniques [9]. ...
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... Multiple myeloma should always be kept in mind in patients presenting with prolonged weakness and fatigue, exhaustion, deep anemia, hypercalcemia, and renal failure. [9] Patients with long standing progressive fatigue and weakness of unknown etiology should be screened for possible plasma cell dyscrasia. ...
Introduction. Although diffuse alveolar damage and
respiratory failure are the key features of coronavirus
disease 2019 (COVID-19), the involvement of other
organs such as the kidney has also been reported. The
reports of the incidence of acute kidney injury (AKI)
in COVID-19 patients vary widely. In this study, we
report our experience with AKI in COVID-19 patients
and provide its incidence, risk factors, and prognosis to
expand the current understanding of this complication.
Methods. In this single-center, retrospective observational study, we analyzed the data of 269 COVID-19
patients admitted to the Clinic for nephrology in Sarajevo, BH, from March 2020 through April 2021. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes
was collected from the electronic medical records. We
excluded COVID-19 patients from our study if they were
on maintenance dialysis or were kidney transplant recipients. The earliest day of the serum creatinine change that met the KDIGO criteria for AKI was selected
as day 1 of AKI. Statistical analyzes were performed
using SPSS 21 Windows (version 21.0).
Results. The median age of the patients was 64.2 years,
and 59.85% of them were male. Most of these patients
presented with dyspnea (96.65%), cough (92.19%), and
fever (87.73%). Of all the patients studied, 69.88% were
discharged, 16.73% died during hospitalization, and
13.38% were transferred to another institution. The incidence of AKI during hospitalization was 28.99%
(n=78) and was significantly higher in patients who
presented with eGFR <60 mL/min/1.73 m2
(65.38 vs.
34.61%). The in-hospital mortality was significantly higher
in patients with an eGFR <60 mL/min/1.73 m2
(26 pts.)
then in patients with an eGFR ≥60 mL/min/1.73m2
(19
pts.) at presentation. Compared with patients without
AKI, patients with AKI had higher levels of white
blood cells (WBC), inflammatory markers, and had
low pulse oxygen saturation at admission. The number of patients requiring renal replacement therapy (RRT)
during hospitalization was 23. In the multivariable model,
AKI (stage 3) is associated with a higher risk of hospital mortality during the follow-up period.
Conclusion. AKI in our hospitalized COVID-19 patients
was common and carried high mortality, especially in
patients with AKI stage 3. RRT did not improve survival.
Keywords: Coronavirus disease 19, Acute kidney
injury, Renal replacement therapy, Hospital mortality
Phosphate (P) is an essential element of life and both
reduced and elevated serum P levels will reduce lifespan.
Kidneys are very important to maintain phosphorus
homeostasis. There is sustained evidence showing that
high serum phosphate concentration is associated with
cardiovascular disease, all-cause and cardiovascular
mortality in chronic kidney disease (CKD), basically
by vascular aging and altered mineral metabolism both
before and after initiation of renal replacement therapy.
On the other hand, the hyperphosphatemia was reported
to have a detrimental impact on kidney function
per se. It might have an independent pathogenic role in
the onset and progression of CKD and might even
attenuate the renoprotective effect of ACE inhibitors in
proteinuric CKD patients. The phosphorus reduction has
been shown as strongest determinant of improvement
in proteinuria. There is some evidence that both posttransplant
hypo-and hyperphosphatemia could be the
reason of adverse outcome in transplanted patients, but
there are still not enough data on disturbed phosphate
metabolism that could bring the guidelines that are
needed. Enhancing the knowledge on P balance and
toxicity is challenging to improve the care of renal patients,
to protect the graft and enable longer kidney and
patient's survival. A healthy phosphate balanced diet may
be important for a healthy life and longevity.
Keywords: phosphate, fibroblast growth factor 23, chronic
kidney disease, proteinuria, kidney transplantation
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