Diabetes and nephropathy is not always equal to diabetic nephropathy
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In a busy diabetes clinic, it is always easy for the diabetologist to equate nephropathy and diabetes to “diabetic nephropathy”. Certain clinical clues should arouse suspicion of non-diabetic renal disease as this may have important implications in patient management. We report a case of multiple myeloma in a patient with diabetes presenting as “diabetic nephropathy”.Myeloma protein
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[Objective] To investigate the levels of macrophage inflammatory protein (MIP)-1alpha in the marrow plasma of the patients with multiple myeloma and the clinic significance. [Methods] MIP -1α was quantified using ELISA assay in 43 multiple myeloma, 15 controls, and 37 post therapy of three course. [Results] ⑴About 65.1% patients with multiple myeloma had increased levels of MIP -1α. A significantly larger proportion of multiple myeloma patients had increased levels of MIP-1α compared to the control (t=3.569,P=0 0.01), a significantly larger proportion of multiple myeloma patients with active disease had increased levels of MIP-1α compared to normal controls, other hematological diseases controls and patients with multiple myeloma with inactive disease(P 0.05). A significantly larger proportion of multiple myeloma patients with more than 2 sites bone destruction had increased levels of MIP-1α compared to the less 2 sites bone destruction (t=5.56,P =0).(2)The levels of MIP -1α in responded patients with multiple myeloma after 3 course of treatment was much higher than those in unresponded patients(t =3.237,P=0 0.05).⑶MIP -1α levels significantly correlated with red blood cell, albumin, β2-microglobulin, the presence of bone lesions and Durie-Salmon stages(P 0.05). [Conclusion] ⑴Most of patients with multiple myeloma had increased levels of MIP -1α in marrow plasma. The levels of MIP-1α can indicate bone disease and myeloma burden. The levels of MIP-1α quantified regularly can forecast curative efficiency.
Beta-2 microglobulin
Myeloma protein
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Oxidative stress is hypothesized to play a role in the development of diabetes with and without nephropathy. In addition, it has been suggested that some metabolic abormalities associated with diabetes may be due to cytokine overproduction. In the light of this knowledge, we aimed to measure MDA levels as a marker of oxidative stress and the IL-6 level in diabetes with and without different stages of nephropathy. Plasma MDA levels in the group of NIDDM patients with advanced nephropathy were significantly higher than in the group of NIDDM patients without nephropathy, which had significantly higher levels compared with the control group. Although IL-6 levels were elevated in diabetic groups with and without nephropathy in comparison with the control, no significant difference was found between patient groups. As a conclusion, oxidative stress may play an important role in diabetes with and without nephropathy, but the IL-6 level may not be useful in the evaluation of diabetic nephropathy.
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Multiple myeloma has varied manifestations which resemble common patient complaints and that is why this disease is typically not diagnosed until it reaches an advanced stage. Spinal pains can be an expression of deformative and discogenous changes, but also a symptom of multiple myeloma. Pains in the long bones may result from the pain radiating from an arthrotic joint, but also from a large myelomatic osteolytic lesion which makes the bone prone to a spontaneous fracture. Pathological weariness may have many causes, multiple myeloma being one of them. Anemia may have a large number of causes and multiple myeloma is one of them. Raised creatinine levels and renal failure can also be due to many causes and again, multiple myeloma is one of them. Weakened immunity and frequent infections can also have many causes, among them multiple myeloma. Confusion and sleepiness may be due to psychiatric diagnosis, but also may result from hypercalcemia associated with multiple myeloma. The following text which is designed for non-hematology physicians therefore describes in detail the symptoms of multiple myeloma and diagnostic steps leading to establishing the diagnosis and it only briefly outlines the treatment related information. You can also visit www.myeloma.cz for details. This text aims to summarize the symptoms of multiple myeloma for physicians not specializing in hematology in order to facilitate earlier diagnosing of the disease.
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Objective To study the clinical characteristics of multiple myeloma with double clones and analyze its related laboratory diagnostic and therapeutic methods.Methods A case of multiple myeloma with double clones of IgG-κ and IgG-λ was reported and its related literature was reviewed.Results The myeloma protein ingredients were different between multiple myeloma with double clones and typical multiple myeloma.Immune fixation electrophoresis was of diagnostic value for multiple myeloma with double clones.The treatment outcome was usually a decreased or disappeared myeloma protein ingredient.The prognosis of patients was rather good.Conclusion Multiple myeloma with double clones is a rare plasma cell disorder,which is different from typical multiple myeloma in clinical manifestations,diagnosis,treatment and prognosis,and should thus be differentially diagnosed from typical multiple myeloma.
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Hematology
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150 autopsies with multiple meyeloma were analysed. In about one third of the cases the multiple myeloma was diagnosed only at autopsy. Two thirds of the carriers of multiple myeloma were between 60 and 70 years old when they deceased. The osseous foci of multiple myeloma extended predominantly to the central parts of the skeletal system. In 120 patients the multiple myeloma was the cause of death. In half of these cases infections, particularly of the lung, had caused death. The second frequent cause of death was uraemia. 63 of the 150 multiple myeloma have been immunologically classified. The cases in question are 10 IgA-, 2 IgD-, and 42 IgG-multiple myeloma. Extraosseous foci of multiple myeloma appeared significantly more frequent in IgA-than in IgG-multiple myeloma. A haemorrhagic diathesis existed more frequent in IgA-multiple myeloma. Venous thromboses were more frequently to be found in IgG-multiple myeloma. Amyloid deposits and changes of the kidneys characteristic for the multiple myeloma appeared nearly in the same frequency in both types of multiple myeloma.
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Multiple myeloma (MM) is the leading cause of death among hematologic neoplasms. Recently, microRNA has been reported to be useful in the diagnosis of multiple myeloma. This study examined whether miR-221 could be used as a diagnostic marker for multiple myeloma. The study was performed on 20 patients with multiple myeloma without any other hematological diseases. MicroRNA extraction was performed using formalin-fixed paraffin-embedded (FFPE) tissues obtained from the bone marrow of patients with multiple myeloma. miR-15a, miR-16, miR-21, miR-181a, and miR-221 were selected as the microRNA target genes for multiple myeloma. The significance of microRNA was based on a fold change of <1.5. to="" quantify="" the="" fold="" changes="" data="" normalized="" to="" the="" human="" gene="" italic="">SNORD43, were used as the values of the patient group. Fold change values greater than 1.5 were defined as “overexpression”, whereas values less than -1.5 were defined as “underexpression”. Of note, 65.0% (13/20) of samples showed significant “overexpression” in the levels of miR-221 expression and plasma cells with a group of more and less than 30% in MM patients did not show any significance of plasma cell (P<0.05). The results of other studies showing a correlation between the expression of miR-221 and MM in Caucasians were confirmed. These results suggest that miR-221 may be a useful indicator for diagnosing patients with MM. In conclusion, miR-221 is useful in the diagnosis and determining the prognosis of multiple myeloma in Koreans.
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High dosage melfalan chemotherapy with subsequent autologous blood stem cell transplantation in suitably selected patients with multiple myeloma greatly increases the probability that complete remission will be achieved and it prolongs the mean survival period as compared with classical chemotherapy. Till recently patients with multiple myeloma and renal insufficiency were not included in transplantation programmes. Only recently several papers were published abroad which indicate the possibility to implement transplantations also in these patients. The authors describe the treatment, incl. the first autologous transplantation of blood stem cells in a patient with multiple myeloma and renal insufficiency.
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Abstract Background Diabetic nephropathy is a common complication of diabetes, which can be prevented by early diagnosis and development. The aim of the present study was to evaluate the expression level of miR-192 and miR-377 in serum samples of diabetic subjects without nephropathy and diabetic nephropathy subjects to investigate these miRNAs as a biomarker for the diagnosis and prognosis of diabetic nephropathy. Methods and Results We reviewed 370 patients diagnosed with diabetes mellitus type 2 (T2D) (190 patients with diabetic nephropathy and 180 patients with diabetes without nephropathy), and 170 healthy control individuals without any history of T2D. Expression analysis of miR-192 and miR-377 was performed by Real-Time PCR. The expression level of miR-192 was significantly increased in the diabetic nephropathy and diabetic without nephropathy groups (p < 0.05 and p < 0.01). Also, the expression level of miR-377 was significantly increased in the diabetic group without nephropathy compared to the control group (P < 0.05), although miR-377 expression in the diabetic nephropathy samples was a significant decrease compared with the diabetic without nephropathy samples (P > 0.05). QRT-PCR results showed that the expressions of miR-192 and miR-377 were significantly lower and higher in the diabetic without nephropathy group than in micro-albuminuria and macro-albuminuria groups, respectively. Conclusions Overexpression of miR-192 and down-regulation of miR-377 were observed in diabetic nephropathy. Up-regulation of miR-192 can be used as a prognostic factor for diagnosing diabetic nephropathy.
Albuminuria
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