Multiple myeloma renal failure

Creatinine clearance < 60 mL/min/1.73 m2 (stages III-V chronic kidney disease), diabetes mellitus (with renal insufficiency), hypertension, chronic heart failure, cirrhosis, nephrosis, age >75 yr, cholesterol emboli syndrome, multiple myeloma (questionable)... 

Leukemia, lymphoma, Hodgkin s disease, or multiple myeloma / Generalized malignancy / Chronic renal failure of nephritic syndrome / Patients receiving immunosuppressive therapy / Organ or bone marrow transplant recipients... 

The commonest causes of death in the Jamaican patients with multiple myelomatosis were bronchopneumonia and other infectious complications, a finding which is compatible with the secondary antibody deficiency syndrome and impaired cellular immunity which occurs in patients with this disease. Bleeding manifestations and renal failure were not uncommon findings, and myeloma kidney was observed in 66% of the cases. Skeletal involvement was observed, but in many cases the typical lesions had to be searched for. Amyloidosis was present in as many as 21% of the patients (Tl) and this may be associated with the high number of patients in Jamaica that are known to excrete Bence Jones protein in myeloma (Mil). 

Monoclonal protein can be detected in serum, urine, or both in greater than 95% of patients with multiple myeloma (D16). Bone marrow plasma cells exceed 10%. Patients with advanced disease may excrete Bence-Jones proteins in urine. Both hypercalcemia and Bence-Jones proteinuria can contribute to renal failure (A6). 

A6. Alexanian, R., Barlogie, B., and Dixon, D., Renal failure in multiple myeloma. Pathogenesis and prognostic implications. Arch. Intern. Med. 150, 1693-1695 (1990). 

In hyperkalaemia, oral administration or retention enemas of a polystyrene sulphonate resin may be used. A sodium phase resin (Resonium A) should obviously not be used in patients with renal or cardiac failure as sodium overload may result. A calcium phase resin (Calcium Resonium) may cause hypercalcaemia and should be avoided in predisposed patients, e.g. those with multiple myeloma, metastatic carcinoma, hyperparathyroidism and sarcoidosis. Enemas should be retained for as long as possible, although patients rarely manage for... 

Paladini G, Tonazzi C, Paladini G, Tonazzi C. Indomethacin-induced hyperkalemia and renal failure in multiple myeloma. Acta Flaematologica 1982 68 256-260. 

Unusual immune side-effects have also been reported in association with IFNa therapy. Chronic hemolytic uremic syndrome was observed in a patient with multiple myeloma treated with IFNa (De Broe ME, personal communication). The post bone marrow transplantation course was complicated and he received several nephrotoxic antibiotics. Three months later a treatment with IFNa was started. Towards the end of the treatment renal function deteriorated. There was partial renal recovery after cessation of therapy. Renal biopsy showed focal mesangio-capillary lesions, mesangiolysis and intracapillary thrombosis consistent with a chronic form of hemolytic uremic syndrome. Ra-vandi-Kashani et al. [49] and Harvey et al. [50] reported 3 other cases of HUS/TTP. Two patients developed renal failure requiring dialysis. E. coli OH157.H7 was grown from the stool of one patient. 

Defective Synthesis (IgM Falls First, Then IgA, Finally IgG) Lymphoid malignancy, multiple myeloma, lymphoma, chronic lymphocytic leukemia Toxic reaction (e.g., renal failure, diabetes mellitus)... 

Deffonzo RA, Humphrey RL, Wright JR, Cooke CR. Acute renal failure in multiple myeloma. Medicine (Baltimore) 1975 54 209-23. 

Johnson WJ, Kyle RA, Pineda AA, O Brien PC, Holley KE. Treatment of renal failure associated with multiple myeloma. Plasmapheresis, hemodialysis, and chemotherapy. Arch Intern Med 1990 150 863-9. 

ZuccheEi P, Pasquali S> Cagnoli L, Ferrari G. Controlled plasma exchange trial m acute renal failure due to multiple myeloma. Kidney Int 1988 33 1175-80. 

Ehe-existent kidney disease, particularly diabetic nephropathy with renal insufficiency, is the major risk factor. Conditions associated with decreased renal blood flow, including congestive heart failure and dehydration, also confer risk. The presence of multiple myeloma has been considered a relative contraindication for contrast use, but the risk appears to be associated with concomitant dehydration, renal insufficiency, or hypercalcemia rather than the diagnosis itself. Both... 

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