A case of light-chain-type multiple myeloma in a hemodialysis patient that was diagnosed based on an elevated free light chain κ/λ ratio alone

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  • 免疫グロブリン軽鎖κ/λ比の上昇が唯一の診断契機となった多発性骨髄腫の血液透析患者の1例
  • 症例報告 免疫グロブリン軽鎖κ/λ比の上昇が唯一の診断契機となった多発性骨髄腫の血液透析患者の1例
  • ショウレイ ホウコク メンエキ グロブリン ケイサk/lヒ ノ ジョウショウ ガ ユイイツ ノ シンダン ケイキ ト ナッタ タハツセイ コツズイシュ ノ ケツエキ トウセキ カンジャ ノ 1レイ

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<p>We report a case of light-chain-type multiple myeloma without serum M-protein in a hemodialysis patient. The patient was a 47-year-old male, who was found to have a serum creatinine level of 1.2 mg/dL, but exhibited no evidence of proteinuria or hematuria. A marked increase in his serum creatinine level (to 6.9 mg/dL) was noted 2 years later, and hemodialysis treatment was started. Left ventricular hypertrophy was diagnosed, and liver dysfunction together with hepatomegaly and splenomegaly were detected 2 months later. The patient gradually developed back pain, and a serum immunoglobulin free light chain (FLC) assay was performed. His κ/λ ratio was extremely high (68.23), and based on the results of a bone marrow biopsy, we made a definitive diagnosis of multiple myeloma. The serum M-protein, which is usually present in multiple myeloma, was not detected at any time. The immunoglobulin FLC κ/λ ratio assay was the key to diagnosing multiple myeloma in this case.</p>

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