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15th July 2024
A 79-year-old lady presented with a 9-month history of feeling generally unwell
A 79-year-old lady presented with a 9-month history of feeling generally unwell, shortness of breath and ankle swelling. On examination, she had oedema to both mid-calves, was breathless whilst seated and had some periorbital puffiness and purpura. Investigations were as follows:
| Serum urea | 22.4 mmol/L (2.5-7.0) |
| Serum creatinine | 339 μmol/L (60-110) |
| Serum corrected calcium | 2.02 mmol/L (2.20-2.60) |
| Serum albumin | 19 g/L (37-49) |
| Urine protein: creatinine ratio | 415 mg/mmol (<30) |
| Urine electrophoresis | free lambda light chains |
| Serum IgG | 8.2 g/L (6.0-13.0) |
| Serum IgA | 0.7 g/L (0.8-3.0) |
| Serum IgM | 2.0 g/L (0.4-2.5) |
| Serum protein electrophoresis | normal |
| Abdominal ultrasound | unremarkable |
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