Abstract: FR-PO184
Hyperphosphatemia as Initial Presentation of Multiple Myeloma
Session Information
- Onconephrology: Clinical and Research Advances - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Bonilla, Marco A., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Pariswala, Tanazul T., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Ali, Mahmoud, Saint Barnabas Hospital, Bronx, New York, United States
- Corona, Antonio, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction
Hyperphosphatemia is commonly seen in patients with kidney failure.However, in patients with normal kidney function, it can be a clue to underlying dysproteinemia
Case Description
A 71-year-old male with a medical history of anemia presented for evaluation of abdominal pain. On presentation vital signs were unremarkable. A physical exam revealed a thin elderly male with temporal wasting.Laboratory evaluation showed hemoglobin of 7.1g/dl, sodium 133mmol/L, K 4.2mmol/L, creatinine 1.4mg/dl, Calcium 8.7mg/dl, albumin 3.3g/dl, total protein 10.3g/dl, Gamma GAP 7g/dl, phosphorus 17.7mg/dl. Further workup is in table1.
Discussion
Our case describes an unusual initial presentation of MM in a patient with severe hyperphosphatemia. Bone marrow biopsy reported plasma cell myeloma with 70% CD138-positive plasma cells, confirming a diagnosis of IgG-kappa-type MM. Spurious electrolyte abnormalities present a challenge for clinicians, pseudo-hyperphosphatemia in patients with MM has been associated with laboratory artifacts. A serum sample from a patient with MM will cause an increase in serum turbidity and its optical density, leading to falsely elevated phosphate levels.
After the diagnosis of MM, hyperphosphatemia was attributed to spurious etiology. He started IV corticosteroids for 4 days, with a striking improvement in the phosphorus level(Figure1). Interventions to lower serum phosphorous in this setting should be avoided if there are normal calcium and kidney function levels. Physicians should be aware that an unexplained hyperphosphatemia might be a diagnostic clue for a paraprotein disease.
Table 1. Further laboratory data
| Laboratory | Value | Reference |
| IFE kappa | 68.56 mg/dl | 0.33-1.94 mg/dl |
| IFE lambda | 0.39 mg/dl | 0.57-2.63 mg/dl |
| Kappa/lambda ratio | 175.79 mg/dl | 0.26-1.65 mg/dl |
| Quantitative IgG | 4175 mg/dl | 700-1600 mg/dl |
| Serum protein Electrophoresis M-spike | 3.9 g/dl | |
| Serum Immunofixation | IgG and Kappa bands. |