Professional Documents
Culture Documents
No one knows
As they arise from post germinal cells in the
lymph node, with Ig gene rearrangement,
extensive somatic hypermutation, and class
switching of IgH genes- they have undergone
antigen selection
Risk Factors
Most significant is age- 96% of diagnoses cases occur in
individuals>45 years, more than 63% of cases are those
older than 65 years
Agricultural occupations, petroleum workers, leather
industries, cosmetologists
PATHOPHYSIOLOGY
Anemia
Bone Pain
MGUS
Infections
Fatigue
Renal Failure
SUSPECT? INVESTIGATIONS
Serum/urine
electrophoresis
Skeletal Survey-
Xray
Whole body CT
Serum free light
chain assay
Serum calcium
CBC
Creatinine-serum
Beta2-microglobulin
Albumin
BONE MARROW BIOPSY
Histological
classifications
Low grade
Marshalko type
Small type
Intermeadiate grade
Cleaved type
Polymorphous type
Asynchronous type
High grade
Blastic type
DIFFERENTIAL DIAGNOSIS
MGUS
Solitary Plasmacytoma
Waldenstrom macroglobulinemia
Amyloidosis
URINARY CASTS
Cylindrical
structures
formed in distal
convoluted
tubule and
collecting ducts
of nephrons
Dislodge and
pass into urine
In acidic
environment,
with Tamm-
Horsfall
mucoprotein-
precipitate
CASTS
Acellular
Hyaline
Granular
Cellular
Waxy
RBC
Fatty
WBC
Pigment
Bacterial
crystal
Epithelial cell
HYALINE CASTS
Solidified Tamm-
horsfall mucoprotein
secreted from tubular
epithelial cells
Cylindrical and clear,
low refractivity
Low urine flow
Concentrated urine
Acidic urine
GRANULAR
Breakdown of
cellular casts
Inclusion of protein
aggregates
(albumin or
immunoglobulin)
Muddy brown cast-
acute tubular
necrosis
WAXY CASTS
High urinary
protein nephrotic
syndrome
PIGMENT CASTS
Hemoglobin
Myoglobin
Bilirubin
Drugs
CRYSTAL CASTS
Oxalates
Urates
Sulfonamides
Ketanaline cast
RBC CASTS
SLE
Post-streptococcal
glomerulonephritis
Goodpastures
Nephritic
syndromes
WBC CASTS
Pyelonephritis
Allergic interstitial
nephritis
EPITHELIAL CASTS
Acute tubular
necrosis
Toxin ingestion:
Mercury
Diethylene glycol
salicylate