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Gary S. Lazar, MD; Donald I. Feinstein, MD

Arch Intern Med. 1981;141(5):655-657.

Abstract
• A patient with early multiple myeloma was initially seen with a severe hyperchloremic metabolic acidosis with a normal anion gap and a urine pH of 6.3. The patient did not have glucosuria, aminoaciduria, or phosphaturia. A bicarbonate loading test showed that the fractional excretion of bicarbonate was less than 5% and confirmed the hypothesis that the patient had a distal renal tubular acidification defect. The pathophysiologic mechanism that caused this defect is unknown, but it is associated with the presence of a serum M component (IgG-) and a urine M component (A light chains). Multiple myeloma should be considered in the differential diagnosis of conditions of patients who have a renal tubular acidification defect.

(Arch Intern Med 1981;141:655-657)

Author Affiliations
From the Division of Hematology, University of Southern California School of Medicine and Los Angeles County-University of Southern California Medical Center, Los Angeles.

Footnotes
Accepted for publication June 3, 1980.

Reprint requests to Division of Hematology, University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Feinstein).

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