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Dr. Rumiana Boneva, Medical University, Department of Nephrology, G. Kochev str. 8, Pleven 5800 (Bulgaria) Dear Sir, Different internal (age, sex, race) and external (chronic antigen stimulation, radiation, drugs) factors are discussed in the etiology ofmultiple myeloma [1]. A review of the literature indicates the acceptance that chronic infections could lead to a local plas-mocyte infiltration which may be followed by a malignant transformation [1-5]. To the best of our knowledge there is no published report of a myeloma in patients with chronic pyelonephritis and dialysis treatment. We report 2 cases with chronic pyelonephritis and chronic renal failure (CRF) where myeloma has been diagnosed in the course of maintenance hemodialysis. The first case was a 52-year-old female admitted to the clinic of nephrology in September 1982 with CRF (creatinine 568 μmol/l). Examinations showed latent chronic pyelonephritis. One year later her creatinine climbed to 986 μmol/l and she was placed on chronic hemodialysis. In the following years many complications occurred: chronic pericarditis, viral hepatitis B, stomach resection for a hemorrhagic erosive gastroduodenitis, cirrhosis of the liver. In 1991 the patient’s state worsened – there were frequent gastrointestinal hemorrhages and manifestations of congestive heart failure. Tests performed on hospital admission showed Hb 50 g/l, total protein 80 g/l, para-proteinemia, 80% of the bone marrow substrate in a myelogram, myeloma cells Mar-shalko type, IgG (lambda) from the immu-noelectrophoresis. Polychemotherapy was not instituted because there were contraindications. Two months after diagnosing the myeloma the patient died of congestive heart failure. Pathoanatomically chronic pyelonephritis with nephrosclerosis, heart hypertrophy and dilatation, cirrhosis of the liver, ascites, multiple myeloma with infiltration of bone marrow and spleen were found. The second case was a 66-year-old male with a history of pulmonary tuberculosis in his youth, elimination of a stone from his left kidney in 1972, and frequent urinary infections. In 1986 a nonfunctioning left kidney and CRF (creatinine 275 μmol/l) were noted. In July 1987 the patient underwent right nephrostomy on account of anuria. Histologi-cally, he proved to have active chronic pyelonephritis and no evidence of renal tuberculosis. One month later he began chronic hemodialysis for terminal renal failure. During the following years the patient

Development of Multiple Myeloma in 2 Patients with Chronic Pyelonephritis and Long-Term Hemodialysis Treatment