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multiple myeloma

Hyperammonemia in Myeloma: Dialyze?

 A middle aged man with IgG kappa multiple myeloma previously treated with bortezomib and lenalidomide presented to the hospital with altered mental status. He had completed chemotherapy months prior to presentation. Shortly after being admitted, he progressed to…

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Pitfalls with paraproteins

We were recently consulted on a patient with a history of multiple myeloma who had developed severe hypercalcemia and acute renal failure. The calcium on admission was 15mg/dl (albumin 2.6) and the patient was treated aggressively with IV…

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Screening tests for multiple myeloma

I recently saw a biopsy for a patient who was suspected of having myeloma-related kidney disease, whose biopsy slides were sent to the pathology department at BWH. Along with them came results from a slew of screening tests,…

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Physiology of serum free light chains

Monoclonal gammopathies generally arise from an abnormal clone that has developed from a single cell of B-cell lineage. The monoclonal protein can be intact immunoglogulin (often associated with free light chain), free light chain (FLC) in isolation, or…

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Bortezomib in Myeloma Cast Nephropathy

Bortezomib is a proteosome inhibitor used primarily in the treatment of relapsed myeloma. However, it is increasingly being used in the management of myeloma cast nephropathy (MCN). Bortezomib binds to, and inhibits the function of, the 26S proteosome…

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Hypercalcemia of Malignancy

Cancer-associated hypercalcemia is the #1 cause for hypercalcemia in the inpatient setting (in the outpatient setting, the main cause is primary hyperparathyroidism). In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by…

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