{"id":11306,"date":"2026-09-13T14:35:46","date_gmt":"2026-09-13T14:35:46","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=11306"},"modified":"2026-09-15T05:26:18","modified_gmt":"2026-09-15T05:26:18","slug":"multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/","title":{"rendered":"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease"},"content":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text]<\/p>\n

Abstract:<\/h2>\n

A 39-year-old man with previously stable diabetic kidney disease presented with rapidly progressive renal failure, hypercalcemia and nephrotic-range proteinuria; evaluation revealed kappa light-chain cast nephropathy, >60% bone marrow plasma cells and extensive skeletal lytic lesions, establishing the diagnosis of multiple myeloma with myeloma kidney superimposed on diabetic kidney disease.<\/p>\n

Presenting complaints:<\/h2>\n

A 39-year-old male Mr.X a known case of diabetes mellitus for 5 years with diabetic retinopathy and diabetic nephropathy, had stable chronic kidney disease with a baseline serum creatinine of 2.0 mg\/dL in January 2026 and recently diagnosed to be hypertensive presented to our hospital with complaints of mild fatigue since 1 month with bilateral pedal edema since 1 month.<\/p>\n

Relevant investigations:<\/h2>\n

On evaluation was found to have serum creatinine of 6.7 mg\/dL and urea of 83.8 mg\/dL. He was also found to have hypercalcemia with a serum calcium of 12 mg\/dL and LFT showed A\/G reversal and urine examination showed hematuria and significant proteinuria, with 24-hour urinary protein of 4.02 g\/day.<\/p>\n

Provisional Clinical diagnosis:<\/h2>\n

Rapidly progressive glomerulonephritis<\/p>\n

Evaluation:<\/h2>\n

Further evaluation for the cause of RPGN\u00a0 revealed an M-band on serum protein electrophoresis, raising suspicion of an underlying plasma cell dyscrasia. Hematology consultation was obtained and a myeloma workup was initiated. Renal biopsy performed on 13 April 2026 showed a single linear core of renal cortex and medulla with up to eight glomeruli, demonstrating focal mild mesangial expansion and hypercellularity without segmental sclerosis, significant basement membrane thickening, endocapillary proliferation or extracapillary proliferation. There was severe acute tubular injury involving the proximal and distal convoluted tubules, with coarse cytoplasmic vacuolations in distal tubular epithelial cells. The distal tubules showed intraluminal bubbly Tamm-Horsfall protein casts and occasional dilated tubules containing homogeneous, glassy, sharply demarcated and focally fractured casts that were PAS negative and polychromatic on Masson’s trichrome stain. The surrounding interstitium was significantly edematous with minimal lymphomononuclear inflammatory infiltrate. Atrophic tubules were thickened and corrugated, with interstitial fibrosis and tubular atrophy involving approximately 5\u201310% of the biopsy. The arteries and arterioles showed no significant light microscopic abnormalities. Congo red staining was negative. Direct immunofluorescence was limited by the absence of glomeruli in the DIF core; however, occasional tubular casts showed kappa light-chain restriction, while IgG, IgA, IgM, C3 and C1q were negative.<\/p>\n

Final renal biopsy report:<\/h2>\n

Light-chain cast nephropathy, Kappa light-chain restricted, with severe acute tubular injury, in a background of diabetic kidney disease, class 2A.<\/p>\n

\"\"<\/figure>\n

This image shows Numerous dilated tubules containing eosinophilic proteinaceous casts.<\/p>\n

Bone marrow aspiration performed on 15 April 2026 demonstrated more than 60% plasma cells, consistent with plasma cell myeloma. PET-CT performed on 16 April 2026 revealed numerous ill-defined, faintly FDG-avid and non-FDG-avid lytic lesions involving the craniofacial bones, bilateral ribs, manubrium sterni, multiple vertebrae, bilateral pelvic bones and appendicular skeleton, consistent with skeletal involvement by multiple myeloma. Mild wedge compression of a few thoracic vertebrae was also noted without significant vertebral collapse or fracture. Both kidneys were fairly normal in size and position, and no other significant metabolically active lesions were identified.<\/p>\n

Final diagnosis:<\/h2>\n

Based on the clinical, biochemical, renal biopsy, bone marrow and PET-CT findings, a final diagnosis of multiple myeloma with myeloma kidney due to kappa light-chain cast nephropathy, superimposed on diabetic kidney disease<\/p>\n

Treatment:<\/h2>\n

Patient was initiated on hemodialysis in view of worsening renal functions. Following hematology review, the patient was initiated on CyBorD-based chemotherapy consisting of cyclophosphamide, bortezomib and dexamethasone, along with denosumab, with the first cycle administered in April 17th 2026. The patient tolerated chemotherapy well and remained hemodynamically stable, while continuing alternate-day hemodialysis for renal failure. He was subsequently followed jointly by the nephrology and hematology teams, and CyBorD chemotherapy was continued. Renal functions improved and the patient was weaned off from dialysis as the Sr.Creatinine has come down to 1.59 and Sr.Calcium is 8.48. The patient subsequently received multiple cycles of chemotherapy, with the sixth cycle commenced in September 2026<\/p>\n

Conclusion:<\/h2>\n

This case highlights the importance of considering plasma cell dyscrasia in patients presenting with rapidly progressive renal dysfunction, particularly in the presence of hypercalcemia, significant proteinuria and an M-band on serum protein electrophoresis, even when pre-existing diabetic kidney disease provides an alternative explanation for chronic renal impairment.<\/p>\n

Key Clinical Learning Points:<\/h2>\n

1)Rapid deterioration of renal function in a patient with diabetes should not automatically be attributed to diabetic kidney disease.<\/p>\n

2) Hypercalcemia + unexplained rapid renal dysfunction + significant proteinuria should raise suspicion for plasma cell dyscrasia.<\/p>\n

3) M-band positivity on serum protein electrophoresis is an important clue toward monoclonal gammopathy.<\/p>\n

4) Renal biopsy was crucial in this patient, demonstrating kappa-restricted light-chain cast nephropathy in addition to pre-existing diabetic kidney disease.<\/p>\n

5) Bone marrow examination showing >60% plasma cells supported the diagnosis of plasma cell myeloma.<\/p>\n

6) PET-CT demonstrated extensive skeletal involvement, supporting systemic multiple myeloma.<\/p>\n

7) Early recognition of myeloma-associated kidney disease is important because prompt anti-myeloma therapy and supportive renal management may influence renal recovery and overall outcome.<\/p>\n

References:<\/h2>\n

1.Sathick IJ, Drosou ME, Leung N. Myeloma light chain cast nephropathy, a review. J Nephrol. 2019;32(2):189-198. doi:10.1007\/s40620-018-0492-4.<\/p>\n

PubMed<\/h3>\n

2.Hutchison CA, Batuman V, Behrens J, Bridoux F, Sirac C, Dispenzieri A, et al. The pathogenesis and diagnosis of acute kidney injury in multiple myeloma. Nat Rev Nephrol. 2012;8:43-51. doi:10.1038\/nrneph.2011.168.<\/p>\n

Nature<\/h3>\n

3.Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548. doi:10.1016\/S1470-2045(14)70442-5.<\/p>\n

PubMed<\/h3>\n

4.Nasr SH, Valeri AM, Sethi S, Fidler ME, Cornell LD, Gertz MA, et al. Clinicopathologic correlations in multiple myeloma: a case series of 190 patients with kidney biopsies. Am J Kidney Dis. 2012;59(6):786-794. doi:10.1053\/j.ajkd.2011.12.028.<\/p>\n

PubMed<\/h3>\n

5.Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, et al. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol. 2023;24(7):e293-e311. doi:10.1016\/S1470-2045(23)00223-1.<\/p>\n

\n
\"\"<\/div>\n
\n

Dr S Karthikeyan
\nPostgraduate in Nephrology
\nKauvery Hospital, Chennai.<\/a><\/b><\/p>\n<\/div>\n<\/div>\n

\n
\"\"<\/div>\n
\n

Dr R. Balasubramaniam
\nChief Nephrologist and Senior Consultant
\nKauvery Hospital, Chennai.<\/a><\/b><\/p>\n<\/div>\n<\/div>\n

\n
\"Dr<\/div>\n
\n

Dr Sangamitra
\nConsultant Pathologist
\nKauvery Hospital, Chennai.<\/a><\/b><\/p>\n<\/div>\n<\/div>\n

[\/vc_column_text][\/vc_column][\/vc_row][\/vc_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text] Abstract: A 39-year-old man with previously stable diabetic kidney disease presented with rapidly progressive renal failure, hypercalcemia and nephrotic-range proteinuria; evaluation revealed kappa light-chain cast nephropathy, >60% bone marrow<\/p>\n","protected":false},"author":2,"featured_media":11307,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[104],"tags":[],"class_list":["post-11306","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ima-journal-september-2026"],"yoast_head":"\nMultiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease\" \/>\n<meta property=\"og:description\" content=\"[vc_section][vc_row][vc_column][vc_column_text] Abstract: A 39-year-old man with previously stable diabetic kidney disease presented with rapidly progressive renal failure, hypercalcemia and nephrotic-range proteinuria; evaluation revealed kappa light-chain cast nephropathy, >60% bone marrow\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/\" \/>\n<meta property=\"og:site_name\" content=\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\" \/>\n<meta property=\"article:published_time\" content=\"2026-09-13T14:35:46+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-09-15T05:26:18+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1308\" \/>\n\t<meta property=\"og:image:height\" content=\"545\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"kh-ima-admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"kh-ima-admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/\",\"name\":\"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease\",\"isPartOf\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg\",\"datePublished\":\"2026-09-13T14:35:46+00:00\",\"dateModified\":\"2026-09-15T05:26:18+00:00\",\"author\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\"},\"breadcrumb\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg\",\"contentUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg\",\"width\":1308,\"height\":545},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\",\"name\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"description\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\",\"name\":\"kh-ima-admin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"caption\":\"kh-ima-admin\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/","og_locale":"en_US","og_type":"article","og_title":"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease","og_description":"[vc_section][vc_row][vc_column][vc_column_text] Abstract: A 39-year-old man with previously stable diabetic kidney disease presented with rapidly progressive renal failure, hypercalcemia and nephrotic-range proteinuria; evaluation revealed kappa light-chain cast nephropathy, >60% bone marrow","og_url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/","og_site_name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","article_published_time":"2026-09-13T14:35:46+00:00","article_modified_time":"2026-09-15T05:26:18+00:00","og_image":[{"width":1308,"height":545,"url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg","type":"image\/jpeg"}],"author":"kh-ima-admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"kh-ima-admin","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/","name":"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease","isPartOf":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage"},"image":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage"},"thumbnailUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg","datePublished":"2026-09-13T14:35:46+00:00","dateModified":"2026-09-15T05:26:18+00:00","author":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb"},"breadcrumb":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#primaryimage","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg","contentUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2026\/09\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease.jpg","width":1308,"height":545},{"@type":"BreadcrumbList","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2026\/multiple-myeloma-presenting-as-rapidly-progressive-renal-dysfunction-in-a-patient-with-pre-existing-diabetic-kidney-disease\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.kauveryhospital.com\/ima-journal\/"},{"@type":"ListItem","position":2,"name":"Multiple Myeloma Presenting as Rapidly Progressive Renal Dysfunction in a Patient with Pre-existing Diabetic Kidney Disease"}]},{"@type":"WebSite","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/","name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","description":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb","name":"kh-ima-admin","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","caption":"kh-ima-admin"}}]}},"_links":{"self":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/11306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/comments?post=11306"}],"version-history":[{"count":2,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/11306\/revisions"}],"predecessor-version":[{"id":11310,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/11306\/revisions\/11310"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media\/11307"}],"wp:attachment":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media?parent=11306"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/categories?post=11306"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/tags?post=11306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}