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World J Diabetes. Jun 15, 2026; 17(6): 121606
Published online Jun 15, 2026. doi: 10.4239/wjd.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, 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
Revised: April 29, 2026
Accepted: May 22, 2026
Published online: June 15, 2026
Processing time: 75 Days and 7.1 Hours
Core Tip
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.