bakpity
Forum Senior
Topics: 28
Posts: 71
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Hi guys!
I found this Q in this years sample materials.
65 years old man brought to ER because of increasing confusion over the past 4 days. he lost 9 kg over the month and has progressive low back pain.Takes thiayid for mild hypertension. Now BP is 156/84. Examination shows tenderness over lumbosacral spine.
Labs>
htc 26%
leukocyte count 3200/mm3
Se Na, K, Cl, HCO3 within normal
Ca 16,8 mg/dl
Creatinin 5,9 mg/dl
BUN 9,8 mg/dl
Phosphorus 4mg/dl
ALP 30 U/L
Uric acid 9,8 mg/dl
X ray of the chest nothing abnormal.
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My problem is that amonst the possible answers both myeloma and renal cell carcinoma seem to be suited.
The age does not help/
Incidence almost the same.
Confusion could be because of hypercalcaemia.
Hypercalcemia is a paraneoplasic syn in RCC, it is present in myeloma
Bone meta could explain low back pains.
So my dear friends what is the clue here<
Txs
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| fried water
Forum Junior
Topics: 4
Posts: 57
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.. i am not sure bakpity, but cud it be more likely a B/L RCC.. becoz of the findings which suggest renal function deterioration (elevated s. creat. and BUN). How would you explain these on the basis of multiple myeloma??
..if you can.. let me know too.
-thanx 
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| fried water
Forum Junior
Topics: 4
Posts: 57
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..okay sorry.. only serum creat. is significantly increased and BUN is within normal limits.
..but even then why is s. creat increased?
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| bakpity
Forum Senior
Topics: 28
Posts: 71
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Well, the thing is that the answer is Myeloma Multiplex. The sad thing is that I still do not see any crucial point according to I could differentiate from RCC.
With regard to your question renal enzymes are not really elevated in this special case, but renal disturbances are common consequences in M.M, because of light chains^ s toxic behaviour causing nephrosis, nephrocalcinosis, or renal failure.
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| no more a loser
Forum Guru
Topics: 140
Posts: 580
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sounds like MM, for RCC they would have mentioned abd mass
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| fried water
Forum Junior
Topics: 4
Posts: 57
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yea right! you are right bakpity. and losergirl also sounds convincing. .. just back pain without abdominal lump, doesnt really click for RCC and then RCC wud tend to spread via renal vein and IVC, i think it is more likely to spread to liver and lungs b4 actually going to vertebrae... but the case history doesnt really support the diagnosis of RCC .. lolz on a second thought though, now that i know the answer.. hahahaha!
--thanx 
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