Date: 10/01/2022

To whom it may concern,

An 82-year-old female a diagnosed case of essential hypertension, chronic obstructive pulmonary
disease under regular medications. She is being evaluated for the chronic anemia. Upon detail
evaluation and investigations, she is being provisionally diagnosed to have Pulmo-Renal syndrome
Rapidly progressive glomerulonephritis, anemia of chronic disease and heart failure with the preserved
ejection fraction. She is also being evaluated for the multiple myeloma vs amyloidosis. She is reluctant
for the bone marrow biopsy as well as renal biopsy

A detailed investigations are as follows

Vitamin B 12= 610 pg/ml

NT-Pro BNP= 22585
SPEP: hypoproteinemia and hypoalbunemia present, no M spike, increased alpha 1 globulin
TB-IFG: negative
Multiple myeloma panel: IgG: 1812, IgM: 217, IgA: 226, Kappa light chain: 285, lambda light chain: 178
K: L >1.6, B2 macroglobulin: 14093
Echocardiography: Moderate TR, Moderate PAH, Trace pericardial effusion EF: 75%
HRCT chest: bilateral pleural effusion, atelectasis of the subsegment, patchy ground glass opacites in the
lungs without any zonal predilection
PBS: normocytic normochromic profile
ANA- IF : positive( 1+ intensity)
C3: normal, C4 normal, IPTH: 198(increased) ,EPO: 3.36( decreased)
Hb: 10, corrected calcium : normal, LDH: normal
RFT : Urea: 356 creatinine( 5.84) NA/K normal

Yours