David is a 72-year-old retired teacher who lives with his 68-year-old wife, Susan, in the Scottish Highlands. Their three adult children do not live nearby but visit their parents when they can.
David has long-standing moderate chronic kidney disease (CKD) and type 2 diabetes, managed with oral hypoglycaemics plus insulin. He has some mild diabetic neuropathy. Susan has Parkinson’s disease. She manages her own personal care but David does most of the housework and shopping.
David has seen his GP and received treatment for two chest infections in the past three months. His HbA1c levels indicate poor diabetes control and at a recent diabetic clinic review a blood test revealed a decrease in David’s kidney function, from an eGFR of
42 ml/min (stage 3 CKD) six-months previously to 28 ml/min. David was referred to a nephrologist because his GP was concerned with this decline in his kidney function.
Blood tests suggested light chain only myeloma. David was referred to a haematologist for review and the haematologist ordered further investigations.
A bone marrow biopsy showed infiltration by 78% abnormal plasma cells, indicative of myeloma . The abnormal plasma cells revealed no high-risk cytogenetic abnormalities and LDH was within normal limits. A skeletal survey showed no focal bone damage.