Li GZ, Liu JY, Hao HY, Zhou H. Clinical mismatches leading to the misdiagnosis of multiple myeloma as diabetic nephropathy: A case report. World J Diabetes 2026; 17(6): 121606 [DOI: 10.4239/wjd.121606]
Corresponding Author of This Article
Hong Zhou, MD, Chief Physician, Professor, Department of Endocrinology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei Province, China. zhoubs2013@hebmu.edu.cn
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Endocrinology & Metabolism
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case-report
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Li GZ, Liu JY, Hao HY, Zhou H. Clinical mismatches leading to the misdiagnosis of multiple myeloma as diabetic nephropathy: A case report. World J Diabetes 2026; 17(6): 121606 [DOI: 10.4239/wjd.121606]
World J Diabetes. Jun 15, 2026; 17(6): 121606 Published online Jun 15, 2026. doi: 10.4239/wjd.121606
Clinical mismatches leading to the misdiagnosis of multiple myeloma as diabetic nephropathy: A case report
Gui-Zhi Li, Jia-Yin Liu, Hui-Yao Hao, Hong Zhou
Gui-Zhi Li, Hui-Yao Hao, Hong Zhou, Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Jia-Yin Liu, Department of Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Co-first authors: Gui-Zhi Li and Jia-Yin Liu.
Author contributions: Li GZ and Liu JY contribute equally to this study as co-first authors; Li GZ conceived and designed the study; Liu JY was involved in data collection and patient follow-up; Hao HY interpreted the laboratory results and drafted the manuscript; Zhou H performed critical revisions of the manuscript for intellectual content, supervised the diagnostic process, and gave final approval of the version to be published; and all authors have read and approved the final manuscript.
AI contribution statement: The authors used AI tools, including ChatGPT and Grammarly, during the preparation of this manuscript primarily for language polishing, grammatical correction, and enhancing the overall readability to meet international academic standards. The authors declare that the Main Text of the manuscript (including the Abstract, Introduction, Case Presentation, Discussion, and Conclusion) was entirely written by the authors and was not generated by any AI tool. All clinical data, diagnostic interpretations (such as the identification of λ-type multiple myeloma and clinical mismatches), and study designs were conceived and executed solely by the authors. No AI tools were used for data analysis or the generation of clinical images. The authors take full responsibility for the integrity and originality of the content.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hong Zhou, MD, Chief Physician, Professor, Department of Endocrinology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei Province, China. zhoubs2013@hebmu.edu.cn
Received: March 30, 2026 Revised: April 29, 2026 Accepted: May 22, 2026 Published online: June 15, 2026 Processing time: 75 Days and 7.1 Hours
Abstract
BACKGROUND
Diabetic nephropathy (DN), characterized by the presence of protein in the urine, is a primary contributor to chronic kidney disease. Nonetheless, the clinical considerations often overlook non-diabetic renal disease (NDRD). Multiple myeloma (MM) is a blood cancer, which can present as renal impairment like DN, leading to delays in diagnosis and prognosis.
CASE SUMMARY
A 60-year-old lady with 12 years of type 2 diabetes (T2D) developed severe anemia with progressive renal insufficiency. Contrary to the occurrence of DN, her clinical profile revealed a suboptimal blood glucose control but three major mismatches. These mismatches were disproportionately severe anaemia not in keeping with the degree of renal impairment; a large gap between high total urinary protein and low albuminuria; and absence of hypertension or edema despite advanced renal failure. A serum protein electrophoresis and bone marrow biopsy were found to confirm the presence of λ-type MM (stage III, group B). Following systemic chemotherapy (bortezomib/dexamethasone), her renal function and anemia improved significantly.
CONCLUSION
When patients with T2D present with atypical renal features, clinicians should consider the possibility of NDRD. Identifying clinical mismatches is essential for the early diagnosis of MM in patients with diabetes.
Core Tip: This case report highlights the diagnostic pitfalls of diabetic nephropathy and identifies three key clinical mismatches—anemia-renal mismatch, protein-albumin gap, and volume-hypertension mismatch—as critical red flags for suspecting multiple myeloma in patients with diabetes. In this patient with a 12-year history of type 2 diabetes, the presence of severe anemia disproportionate to renal impairment, massive total proteinuria with a low urinary albumin-to-creatinine ratio, and the absence of hypertension or edema served as vital clues for identifying non-diabetic renal disease.
