GERALDINE P. SCHECHTER, M.D.
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To the editor: Border and Cohen (1) recently reported four cases of renal insufficiency in which renal biopsy was used to make the "clinically silent" diagnosis of multiple myeloma. Although the point was not clearly stated in the paper, the diagnosis was apparently "silent" because of the common failure to appreciate that screening tests for monoclonal immunoglobulin production should include electrophoresis of concentrated urine as well as of serum (2). A paraprotein is usually not detectable by serum electrophoresis in the 15% to 20% of patients with myeloma who have light chain disease. All the patients reported by Border and
SCHECHTER GP. Renal Failure and Multiple Myeloma. Ann Intern Med. ;93:643–644. doi: 10.7326/0003-4819-93-4-643_2
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Published: Ann Intern Med. 1980;93(4):643-644.
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