Factors in the Renal Failure of Multiple Myeloma

Acute Renal Failure in Multiple Myeloma after the Ingestion of a Contrast Agent for Cholecystography

“…The patient reported here never recovered renal function in contrast to the other 9 reported patients [6][7][8][9][10]. The probable cause of acute renal failure induced by iodinated radio-contrast dyes is intraluminal obstruc tion of renal tubules by urinary proteins [4,5], In our patient, the excretion of large amounts of free light chains in the urine could have been the probable precipitating factor in the development of acute renal failure after an oral dose of iopanoic acid.…”

“…It is usually precipitated by hypercal cemia, infection associated with volume depletion or the administration of potentially nephrotoxic antibiotics. In a rare instance, intravascular injection of iodine-contain ing contrast dyes had led to acute renal failure [3][4][5]. We report here a patient with multiple myeloma who devel oped acute renal failure after a single oral dose of 3 g of iopanoic acid (Telepaque) as a contrast agent for chole cystography.…”

“…Progressive chronic renal failure in multiple myeloma patients is common and occurs at some time during this illness in about half of the patients [I, [3][4][5], In contrast, acute renal failure without preceding renal impairment is not common, occurring in only 8.7% of the patients re ported in a recent series [2]. Earlier reports emphasized the role of intravenous pyelography in precipitating acute renal failure, but this incidence is probably low [1,2].…”

Plasma Exchange in Rapidly Progressive Renal Failure Due to Multiple Myeloma

“…Light chains now appear in the tubular fluid and travel to the distal tubule where they combine with Tamm-Horsfall protein to form an obstructing intratubular cast. This obstruction can result in acute and, if persistent, end-stage renal failure [15][16][17]. Although several mechanisms are proposed to explain the occurrence of rapidly progressive renal failure in multiple myeloma, the roles of excess light chains and the proximal tubular damage and associated distal cast formation are thought to be central to the pathogenesis of the rapidly progressive renal failure [2][3][4][18][19][20][21][22][23].…”

Monitoring the Blood pH in Acute Myocardial Infarction

“…Laboratory studies done at this time showed the follow¬ ing values: serum potassium, 4 mEq/liter; 6-hour thyroid uptake, 10%, and 24-hour uptake, 23%; red blood cell up¬ take of liothyronine I 131 (triiodothyronine tagged with I31I), 14.8% (normal, 12% to 19%); thyroid hemagglutination test with tanned red cells, 1:5 (normal, 1:5 or less); and Achilles tendon reflex time, 0.34 seconds (normal, 0:28 to 0:38 seconds).…”