Treatment of multiple myeloma with renal involvement: the nephrologist’s view

Favà, Alexandre; Fulladosa, Xavier; Montero, Núria; Draibe, Juliana; Torrás, Joan; Gomà, Montse; Cruzado, Josep M.

doi:10.1093/ckj/sfy065

Cited by 15 publications

(12 citation statements)

References 43 publications

(52 reference statements)

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“…Sometimes the occurrence of acute kidney failure is initial manifestation of multiple myeloma, with kidney damage most often the consequence so called cast nephropathy -"myeloma kidney",which represents tubular damage caused by precipitation of light chain immunoglobulins, followed by deposits of light chains, amyloidosis, hypercalcaemia, drugs, etc. (17,18). At the moment of diagnostic MM, the existence of acute kidney failure is described in 20-40% of cases, and in severe cases it is accompanied by oliguria, so dialysis is necessary, as was the case with our patient (19).…”

Section: Discussionsupporting

confidence: 56%

Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

et al. 2021

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Introduction. Kidney failure in multiple myeloma is sometimes an initial symptomatology and a very serious complication with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by proliferation of plasmocytes in the bone marrow, and in rare cases it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare extramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case report. We present a patient with a progression of acute kidney failure where hemodialysis treatment started. On the chest radiography, a homogeneous shadow was observed along the left chest wall, and MSCT pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles and V rib destruction. Laboratory examination indicated presence of Bence -Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperuricemia. After bronchoscopy and needle biopsy, diffuse infiltration of mature plasma cells was demonstrated in the cytological and pathohistological findings of the lungs. The pathohistological finding of bone marrow biopsy indicated multiple myeloma -Lambda type with infiltration of plasma cells -about 70%. Hematologist determined a diagnosis of multiple myeloma BJ lambda III BCS, with extramedullary lung infiltration and acute kidney failure. Further treatment was continued according to the hematological protocol while performing intermittent hemodialysis.Conclusion. Sometimes, extremely rarely, and in completely asymptomatic patients with massive pulmonary infiltration observed initially, differential diagnosis may also represent an extramedullary presentation of a multiple myeloma, which should be considered.

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Section: Discussionsupporting

confidence: 56%

Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

et al. 2021

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“…Rapid reduction of light chains is the most important step in the treatment. Early reduction in these chains is associated with an increased rate of renal function recovery (43)(44)(45).…”

Section: Extracorporeal Blood Purification Techniques In Oncologymentioning

confidence: 99%

Renal replacement therapy in cancer patients with acute kidney injury (Review)

et al. 2021

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Cancer patients are at high risk for developing acute kidney injury (AKI), which is associated with increased morbidity and mortality in these patients. Despite the progress made in understanding the pathogenic mechanisms and etiology of AKI in these patients, the main prevention consists of avoiding medication and nephrotoxic agents such as non-steroidal anti-inflammatory drugs, contrast agents used in medical imaging and modulation of chemotherapy regimens; when prophylactic measures are overcome and renal impairment becomes unresponsive to treatment, renal replacement therapy (RRT) is required. There are several methods of RRT that can be utilized for patients with malignancies and acute renal impairment; the choice of treatment being based on the patient characteristics. The aim of this article is to review the literature data regarding the epidemiology and management of AKI in cancer patients, the extracorporeal techniques used, choice of the appropriate therapy and the optimal time of initiation, and also the dose-prognosis relationship.

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“…MM is a plasma cell dyscrasia that accounts for almost 10% of all hematologic malignancies [ 19 ]. Patients with MM have approximately a 50% chance of developing acute kidney injury (AKI) or CKD during the course of their disease [ 20 ], while 25-50% have kidney dysfunction at presentation, and approximately 9% require hemodialysis (HD) [ 21 ]. Renal disease in MM range from renal insufficiency, proteinuria, renal tubular dysfunction, and rarely, Fanconi syndrome [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Bone Marrow Findings in Renal Patients: A Single Renal Specialist Center Experience

Nasir¹,

Qureshi²,

Qureshi³

et al. 2021

Cureus

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This study evaluated the importance of bone marrow aspiration and trephine biopsy (BM) for the diagnosis of underlying hematological abnormalities in renal patients. MethodsThis cross-sectional study on BM was carried out between August 2010 and April 2019, in our specialist renal center for various unexplained hematological abnormalities in patients with renal diseases [chronic kidney disease (CKD), end-stage renal disease (ESRD) requiring maintenance hemodialysis (MHD), patients with normal renal function but other nephrology and urology issues like stone disease and nephrotic syndrome]. ResultsOut of 176 reported BM examinations, 48 (27.3%) were done on ESRD patients on MHD (CKD-D), and 69 (39.2%) on CKD patients not on MHD (CKD-nD). Fifty-nine (33.5%) BM were done on patients with normal renal function (n-CKD). The indication for BM was pancytopenia 50 (28.4%), unexplained anemia 39 (22.2%), and unexplained thrombocytopenia 43 (24.4%). In 91 (51.7%) patients BM was normal. In 30 (17%) patients multiple myeloma (MM) was diagnosed on BM, out of which 18 (26.1%), nine (18%), three (5.3%) were CKD-nD, CKD-D, and n-CKD patients, respectively. In 11 (6.3%) patients BM was suggestive of myelodysplasia (MD), out of these 11 patients, five (10%) were CKD-D patients. ConclusionBM is an underutilized method of diagnosis of hematological abnormalities in renal patients. Our study revealed the importance of BM examination, especially in patients with CKD.

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Treatment of multiple myeloma with renal involvement: the nephrologist’s view

Cited by 15 publications

References 43 publications

Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

Renal replacement therapy in cancer patients with acute kidney injury (Review)

Bone Marrow Findings in Renal Patients: A Single Renal Specialist Center Experience

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