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.

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

DIAGNOSIS: 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.

MANAGEMENT: Potassium supplementation, sodium bicarbonate therapy, intravenous fluid therapy and dialysis.