PRESENTATION AND DIAGNOSIS

Nearly 50% of patients with myeloma cast nephropathy have acute kidney injury; the remaining cases are either subacute or chronic. A typical presentation in a patient without known myeloma is several weeks of oliguria, weakness, fatigue, lethargy, and lower extremity edema with newly diagnosed severe renal insufficiency. In contrast, a patient with a known myeloma diagnosis will often be noted to have an asymptomatic rise in creatinine on routine laboratory evaluation. Some of the known precipitants, listed previously, may be noted in the recent clinical history.