Differential Diagnosis for Elevated Kappa and Lambda Light Chains with Elevated Calcium and CKD
- Single Most Likely Diagnosis
- Multiple Myeloma: This is the most likely diagnosis given the combination of elevated kappa and lambda light chains, hypercalcemia, and chronic kidney disease (CKD). Multiple myeloma is a plasma cell disorder characterized by the proliferation of malignant plasma cells in the bone marrow, leading to an overproduction of light chains, which can cause kidney damage and hypercalcemia due to bone resorption.
- Other Likely Diagnoses
- Monoclonal Gammopathy of Undetermined Significance (MGUS): Although MGUS is a precursor to multiple myeloma, it can also present with elevated light chains and may be associated with CKD and hypercalcemia, albeit less commonly than in multiple myeloma.
- Light Chain Amyloidosis (AL Amyloidosis): This condition involves the deposition of light chain amyloid fibrils in various tissues, including the kidneys, which can lead to CKD. While it may not directly cause hypercalcemia, the associated renal impairment can contribute to disturbances in calcium metabolism.
- Do Not Miss Diagnoses
- Hyperparathyroidism: Although less directly related to elevated light chains, primary hyperparathyroidism can cause hypercalcemia and CKD. It's crucial to rule out this condition due to its potential for significant morbidity if left untreated.
- Lymphoma: Certain types of lymphoma can produce light chains and lead to kidney impairment and hypercalcemia. Missing a diagnosis of lymphoma could have significant implications for treatment and prognosis.
- Rare Diagnoses
- Heavy Chain Disease: A rare condition characterized by the production of abnormal heavy chains, which can be associated with lymphoproliferative disorders and may present with renal impairment and other systemic symptoms.
- POEMS Syndrome: A rare paraneoplastic syndrome associated with a plasma cell disorder, characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. It can lead to CKD and may have associated hypercalcemia, although this is less common.