title: [Acute renal failure in IgM plasmocytoma with hyperviscosity syndrome].
abstract: METHODS
  Two days after starting withdrawal treatment for alcohol and drug abuse a 56-year-old woman developed acute renal failure. The patient was in a poor general condition and disoriented as to time and place. She had uraemic oral fetor and leg oedema. She had previously fractured both arms 3 months before.
  
  
  METHODS
  Biochemical tests indicated renal failure: creatine 1791 mumol/l, urea 51.7 mmol/l, potassium 5.3 mmol/l, phosphate 1.86 mmol/l. Serum protein electrophoresis suggested paraproteinaemia with M gradients in the gamma-fraction. Immune fixation electrophoresis demonstrated monoclonal IgM gammopathy of kappa-type (IgM 44.1 g/l). Haemoglobin level was reduced to 66 g/l. Bone marrow biopsy showed replacement of normal haematopoiesis by highly atypical plasma cells (> 30% of cell population). Magnetic resonance imaging revealed diffuse changes in the pelvis and vertebrae suggesting plasmacytoma, confirming the diagnosis of IgM plasmacytoma of kappa-type.
  
  
  METHODS
  Focal neurological symptoms (e.g. intermittent anisocoria and visual disturbances) suggested a hyperviscosity syndrome, although the serum protein level was nearly normal. Plasma viscosity was 2.2 mPas (normal range 1.2-1.38 mPas), lowered to 1.5 mPas by plasmapheresis, after which the neuropsychiatric symptoms improved. Chemotherapy for the plasmacytoma in stage IIIB was initiated (VAD scheme) and dialysis became necessary for terminal renal failure.
  
  
  CONCLUSIONS
  Due to the raised level of IgM protein level and its high molecular size a hyperviscosity syndrome with paraproteinemic coma may occur, even though total plasma protein is nearly normal.
authors.affiliation: Medizinische Klinik I, Medizinischen Universität Lübeck.
authors.forename: M
authors.initials: M
authors.lastname: Nitschke
authors.forename: K
authors.initials: K
authors.lastname: Fink
authors.forename: S
authors.initials: S
authors.lastname: Pawlow-Handt
authors.forename: A
authors.initials: A
authors.lastname: Leeker
authors.forename: P M
authors.initials: PM
authors.lastname: Rob
authors.forename: J
authors.initials: J
authors.lastname: Steinhoff
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001797:Blood Protein Electrophoresis; D001809:Blood Viscosity; D003907:Dexamethasone; D004317:Doxorubicin; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D007122:Immunoelectrophoresis; D007075:Immunoglobulin M; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy; D010956:Plasmapheresis; D006435:Renal Dialysis; D013577:Syndrome; D014750:Vincristine
chemical_list: D007075:Immunoglobulin M; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin