Combined renal tubular acidosis and diabetes insipidus in hematological disease.
BACKGROUND
A 39-year-old male with multiple myeloma was admitted for treatment with melphalan and autologous stem cell reinfusion. He presented with hypokalemia and hyperchloremic non-anion-gap metabolic acidosis with a high urinary pH. He also had hypomagnesemia, hypophosphatemia, hypouricemia, proteinuria and glucosuria. The patient subsequently developed polyuria with a low urine osmolality, hypernatremia and, finally, acute renal failure.


METHODS
Physical examination, blood and urine analyses, kidney biopsy and tonicity balance.


METHODS
Fanconi syndrome with proximal (type II) renal tubular acidosis caused by myeloma kidney. Renal tubular acidosis was complicated by probable nephrogenic diabetes insipidus and acute renal failure.


RESULTS
Potassium supplementation, sodium bicarbonate therapy, intravenous fluid therapy and dialysis.
Hoorn
Ewout J
EJ
Erasmus Medical Center, Rotterdam, The Netherlands. ejhoorn@gmail.com
Zietse
Robert
R
D000141:Acidosis, Renal Tubular / Q000139:chemically induced / Q000150:complications* / Q000209:etiology*; D058186:Acute Kidney Injury / Q000150:complications / Q000473:pathology; D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced / Q000150:complications*; D005198:Fanconi Syndrome / Q000209:etiology; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000150:complications; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy
D000935:Antifungal Agents; D000666:Amphotericin B