Diagnostic Challenges in Multiple Myeloma: A Case of Recurrent Acute Kidney Injury, Hypercalcemia, and Anemia

By Klejda ÇOLLAKU, Erjola LIKAJ, Polikron PULLUQI, Adela PEROLLA

Abstract
Multiple myeloma (MM) is a hematologic malignancy with heterogeneous clinical presentations, often delaying diagnosis [1,3,4]. Renal impairment is one of its most frequent and severe complications, primarily due to light-chain cast nephropathy, hypercalcemia-induced nephropathy, or nephrotoxic exposures [2,5,10]. We present a case of recurrent acute kidney injury (AKI), episodic hypercalcemia, progressive anemia, and disproportionately elevated inflammatory markers, including
hyperferritinemia and markedly elevated D-dimer (>10,000 ng/mL),which initially suggested alternative etiologies such as infection, thromboinflammation, or macrophage activation, but may also reflect tumor activity [9,11]. Serial clinical deterioration ultimately led to a bone marrow aspirate confirming MM [8,13]. This case underscores the diagnostic challenges of MM when renal involvement and inflammatory dysregulation dominate the early clinical picture [6,12]. It highlights the importance of timely hematologic evaluation, repeated assessment of monoclonal components, and early suspicion of myeloma kidney in patients with unexplained recurrent renal dysfunction [2,5,10].