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) |