Clinical features of myeloma Alternate diagnoses that can mimic myeloma
Hypercalcemia (13% at diagnosis) Increased osteoclastic bone resorption Increased renal tubular calcium resorption Hypercalcemia Primary hyperparathyroidism Tertiary hyperparathyroidism (CKD, vitamin D deficiency) Malignancy (e.g. bone metastases) Drugs (e.g. thiazides, lithium, vitamin D, vitamin A) Endocrine conditions (e.g. thyrotoxicosis, Addison’s disease) Granulomatous conditions (e.g. sarcoidosis, tuberculosis) Other (e.g. prolonged immobilization, milk-alkali syndrome)
Renal failure (19% at diagnosis) Light chain cast nephropathy Hypercalcemia Monoclonal immunoglobulin deposition disease Plasma cell infiltration of the kidneys Concurrent amyloidosis Drug-induced (NSAIDs, bisphosphonate) Renal failure AKI (acute kidney injury) Prerenal causes (e.g. dehydration, sepsis) Renal causes (e.g drug-induced, infections) Postrenal causes (e.g. acute urinary retention) CKD (chronic kidney disease)( 60% of >80 year old) Age-related decrease in eGFR Hypertension Diabetic nephropathy Drug-induced (eg diuretic, NSAIDs) Obstructive uropathy (e.g. due to BPH) Glomerulonephrities
Anemia (35% at diagnosis) Bone marrow infiltration by plasma cells Cytokine-mediated suppressive effect on erythropoiesis Renal failure (decreased erythropoietin production) Anemia (25% of >80 year old) Anemia of chronic disease Iron deficiency (dietary and/or blood loss) Vitamin B12 or Folate deficiency Chronic kidney disease Myelodysplasia Others (e.g. hemolytic anemia, thalassemia)
Bone pain (58% at diagnosis) Increased osteoclast activity causing lytic bone lesions, osteoporosis, pathological fractures Plasmocytomas affecting the bone Bone Pain Nonmalignant causes Osteoporosis Osteomalacia Osteomyelitis Paget’s disease Injury (e.g. fractures) Malignant causes Primary bone cancer Bony metastases (e.g breast, prostate, lung, thyroid, kidney, testicular, ovarian)