Multiple myeloma with paraproteinemia and terminal chronic renal failure on the background of hemodialysis: therapy for concomitant refractory hypertension and heart failure (clinical case)

A complex clinical case of stage III multiple myeloma (MM) in a 60-year-old patient with multiple organ lesions is presented, illustrating diagnostic and therapeutic challenges in modern hematology. The emphasis is on the exceptional clinical polymorphism of the disease, which leads to prolonged "diagnostic wandering": the patient consistently exhibited bone (imitating osteochondrosis), renal (terminal chronic renal failure – CRF – requiring hemodialysis) and cardiac (refractory hypertension, heart failure) syndromes.The diagnosis was verified based on a complex of laboratory (IgG paraproteinemia, Bence Jones protein excretion, hyperproteinemia, a sharp increase in β2-microglobulin >16,000 ng/L) and instrumental methods (CT, MRI), those who have identified a widespread osteodestructive process. A special feature of the case is a combination of life-threatening complications: myeloma nephropathy with stage V CRF on programmed hemodialysis, refractory arterial hypertension, chronic heart failure with reduced ejection fraction and secondary anemia. The article analyzes in detail the therapeutic dilemmas caused by the need to balance between aggressive antitumor treatment (VD scheme – bortezomib + dexamethasone) and correction of severe concomitant pathology that limits the possibilities of therapy. Interdisciplinary recommendations of a hematologist, cardiologist, and nephrologist are presented, and the choice of medications is justified, taking into account multiple organ failure and the high risk of drug interactions. Keywords: multiple myeloma, end-stage renal failure, hemodialysis, resistant arterial hypertension, chronic heart failure.