Table 1 Summary of investigations
Urinalysis | Arterial blood gas | ||
|---|---|---|---|
Urine pH | 7.5 | pH | 7.2 |
Protein | Nil | Bicarbonate | 8.2 mmol/l |
Glucose | Nil | pCO2 | 20 mmHg |
Pus cells | Few | Base excess | −17 |
Red cells | 1–2 | Anion gap | 15 mmol/l |
Casts | Nil | Fractionated bicarbonate excretion | 3 % |
Crystals | Nil | ANA | Negative |
Urinary anion gap | Negative | Complement levels (C3, C4) | Normal |
Urinary Sodium | 32 mmol/l | Rheumatoid factor | Negative |
Urinary Pottasium | 45 mmol/l | 24 h urinary excretion | |
Blood Biochemistry | Oxalate | 0.21 mmol/d (0.04–0.32) | |
Na | 145 mmol/l | Phosphate | 25.6 mmol/d (12.9–42) |
K | 2.9 mmol/l | Uric acid | 476 mg/d (250–750) |
Cl | 115 mmol/l | Calcium | 5.1 mmol/d (2.5–7.5) |
Glucose | 105 mg/dl | Citrate | 720 mg/day (>600) |
Total Protein | 88 g/l | Serum protein electrophoresis | |
Albumin | 29 g/l | Monoclanal band in gamma region | |
Globulin | 59 g/l | Paraproteinaemia | 36.7 g/l |
Creatinine | 82 μmol/l | Immunofixation | IgG Kappa Myeloma |
Ionized calcium | 1.1 mmol/l | Bone marrow aspiration | |
ALP | 147 U/l | 15 % bone marrow clonal plasma cells | |
Chest radiograph | Normal | ||
Contrast CT chest and abdomen | Urine protein electrophoresis & Immunofixation | ||
Bilateral nephrolithiasis | Absent light chains in urine | ||
Mantoux | Negative | ||