多發性骨髓瘤合併腎功能受損及腎水腫的罕見病例報告

徐則中¹、 廖偉創²、 張彰琦²

臺北市立聯合醫院仁愛院區外科部泌尿科¹； 忠孝院區外科部泌尿科²

Multiple myeloma with impaired renal function and hydronephrosis– a rare case report

Tze-Jung Shiu¹, Liao W.C.², Chang-Chi Chang²

Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch¹, ZhongxiaoBranch², Taipei, Taiwan

Introduction

We introduce a multiple myeloma case with impaired renal function and left hydronephrosis.

Case presentation

A 45-year-old male patient had no underlying disease. He suffered from acute lower back pain for 1 week, and he went to our emergency room for help on 2026/02/05. Physical examination revealed no costovertebral angle knocking tenderness. Urine analysis reported pyuria, hematuria, and proteinuria 2+. K.U.B. showed no obvious urolithiasis and L-S spine X-ray lateral view showed T12 vertebral compression fracture. Then, he referred to our orthopedics and nephrological out-patient department for follow-up. Blood test showed anemia(Hb 7.9 g/dl), elevated creatinine(2.69 mg/dl), and proteinuria(UPCR 3149 mg/g). Renal echo showed left hydronephrosis. Abdominal CT showed left hydronephrosis without obvious urolithiasis. Then, he was referred to our urological department. Then he was adimitted and underwent left ureteroscope examination with double-J stent insertion on 2026/03/18. Left ureter-vesical junction and lower-third ureter stricture was noted, but no urolithiasis nor tumor lesion was found. During hospitalization, follow-up lab data showed creatinine elevated up to 3.1 mg/dl, and low IgG and low IgM was noted. so we consulted Hema/Oncological specialist for further evaluation. Further blood exam showed lambda free light chain 8230.00 mg/L. Therefore, multiple myeloma, IgA-lambda type was impressed, and the patient was referred to medical center for myeloma treatment.

Discussion

Reference