![]() Ĭast nephropathy is the commonest cause of renal injury in MM, followed by hypercalcemia. Data from the United States Renal Data System (USRDS) and European Renal Association-European Dialysis and Transplant Association Registry have shown that about MM contributed to 1.5% of all cases of renal replacement therapy (RRT), and the overall mortality among ESRD with MM was 58% when compared to 31% among the general population. The risk factors that can predispose renal injury in patients with a history of monoclonal gammopathies includes an underlying degree of chronic kidney disease (CKD), volume status, electrolyte derangements (hypercalcemia, hyperuricemia), use of loop diuretics, and nonsteroidal anti-inflammatory agents (NSAIDs) along with administration of contrast dyes. It has been shown that not all patients with FLCs have renal disease, suggesting the intrinsic property of the FLCs and their nephrotoxicity. There is a high risk of precipitation when the pH of the solution reaches the pH of the proteins (amino acids). Interestingly, not all the FLCs can cause renal injury, as the FLCs are made of amino acids with different electrical charges creating a different isoelectric point. The renal injury is dependent upon the free light chains (FLCs) concentration in the urine. Kidney involvement has been well documented in patients with plasma cell disorders secondary to multiple causes such as immunoglobulin-dependent, Ig-independent, glomerulonephritis (GN), and direct parenchymal invasion by the plasma cells. About 80% of the patients with MM have chromosomal abnormalities, and the remaining have genetic abnormalities. The United States accounts for about 1% of all cancers and about 17% of all hematological malignancies. The annual incidence in the United States is about 5.6 cases per 100,000. MM can affect any race, but it is twice as common in African Americans, predominant in men, and the median age is about 65 to 70 years. Kidney involvement can also be seen in patients with monoclonal gammopathy of undetermined significance (MGUS) and is called monoclonal gammopathy of renal significance (MGRS). Occasionally minimal change disease or membranous disease can also be seen. ![]() GN can present as membranoproliferative, crescentic, or cryoglobulinemia. Non-immunoglobulin (Ig) mediated, or Ig-independent mechanisms include hypercalcemia, volume depletion, sepsis, tumor lysis, medication toxicity, and plasma cell invasion of the renal parenchyma. The most common renal injury is an immunoglobulin (Ig) mediated, which includes cast nephropathy (also known as myeloma kidney), monoclonal immunoglobulin deposition disease (MIDD), and light chain amyloidosis (AL). The renal injury can be categorized into immunoglobulin (Ig) mediated, non-immunoglobulin (Ig) mediated, and glomerulonephritis (GN). Despite significant advances in treating multiple myeloma, the overall prognosis of renal recovery is still poor. Abnormal renal indices can be the first sign of multiple myeloma or light chain amyloidosis. The most common ones include solitary plasmacytoma, monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma, multiple myeloma (MM), and immunoglobulin light chain amyloidosis (AL amyloidosis). Monoclonal gammopathies are characterized by the monoclonal proliferation of the lymphoplasmacytic cells in the bone marrow and monoclonal immunoglobulins (Igs) deposition in the tissues. At the time of presentation, about 50% of the patients could have involvement of the kidney, and it is associated with higher mortality. The involvement of the kidney in MM and other plasma cell dyscrasias is widespread. Multiple myeloma (MM) is a plasma cell disorder characterized by clonal proliferation of malignant plasma cells producing monoclonal proteins and causing organ damage. ![]() Summarize the treatment of multiple myeloma of the kidney and coordination of interprofessional team in its management.Review the pathology of myeloma kidney.Explain why early diagnosis of kidney involvement of multiple myeloma is important.Describe the epidemiology of multiple myeloma involving the kidneys.This activity examines when myeloma kidney should be considered, how it should be managed, and the role of interprofessional teams in the care of patients with this condition. Renal involvement is associated with higher mortality. At the time of presentation, about 50 percent of patients have renal involvement. Renal disease in patients with multiple myeloma is sometimes referred to as myeloma kidney. The involvement of the kidney in plasma cell dyscrasias, including multiple myeloma, is widespread. ![]() ![]()
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