Q: My father is 70 years old. He has been suffering from hypertension and diabetes for more than 12 years. Despite his age, he is normally very active and energetic. His weight is 47 kgs. About 3 months ago, he complained of not feeling energetic and felt exhausted even after a small walk. Upon tests, his haemoglobin was found to be 7.6. He underwent a course of Victofol injections, but the Hb level did not increase. We then consulted a haematologist. A urine test indicated that there was excessive creatinine being passed through the urine. The doctor blamed this on the history of diabetes and hypertension and has advised an Erythropoetin course. However, he also suggested a couple other tests: B2 Microglobulin and Urine BJ proteins. The BJ protein test has come out positive. The B2 Microglobulin count too is exorbitant. The doctor has suggested a bone marrow test, suspecting multiple myeloma. I would like to know what are the chances of just the renal failure to be causing BJ protein discharge? If it is multiple myeloma, what is the life expectancy?

A:The renal failure is likely a combination of the underlying diseases viz multiple myeloma, diabetes and hypertension. You do not mention any previous creatinine level but if this was normal a year ago then the renal failure is most likely almost exclusively due to the multiple myeloma. Multiple myeloma is a kind of cancer of the plasma cells in the bone marrow. This disease has to be staged. There are several factors which go into the staging of multiple myeloma. A markedly elevated B2 microglobulin speaks of a worse prognosis than if the level was normal. However, as with everything in medicine, one must put the entire picture in context and see what some of the other prognostic marker levels are and what stage of multiple myeloma your father has. Life expectancy is estimated at a few months in patients with advanced disease or it can be 5 years in 50% of patients. Once the disease has been staged and the response to treatment ascertained only then can one give a better indication of life expectancy. You mention that your fathers weight is 47 kg. This is a matter of concern. He should be evaluated for any additional underlying condition that might be responsible for this.