(Cancer) (Renal & Urology)

Overview

• Haemotological malignancy characterised by plasma cell proliferation (results in excessive monoclonal immunoglobulin production) ****& infiltration of the bone marrow by plasma cells
• M>F, median age of presentation is at 70 yrs old
• Classified based on immunoglobulin type → IgG and IgA for the majority of patients

Making Diagnosis

Clinical Features:

• Bone Pain → especially back pain. Can lead to pathological fractures.
• Anaemia → as bone marrow becomes suppressed. Can lead to fatigue and SOB.
• Hypercalcaemia (reduces neuromuscular excitability) → abdominal pain, constipation, nausea, anorexia, confusion, polyuria, polydipsia.
• Renal Impairment → light chain deposition within renal tubules causes renal damage (acute tubular necrosis) which leads to dehydration and increasing thirst.
• Increased susceptibility to infection

<aside> 💡 CRABI → Calcium (High), Renal Impairment, Anaemia, Bone Pain, Infections

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Investigations:

• Serum or Urine Electrophoresis → best initial test. Raised concentrations of monoclonal IgA/IgG proteins will be present in the serum. (Will have one type of Ig being produced in excess - monoclonal band seen). Bence Jones proteins may be seen in urine.