Editor’s Pick: Renal Involvement in Multiple Myeloma

Fifteen years ago, renal involvement and renal failure were almost inevitable consequences of multiple myeloma, dramatically impacting survival and quality of life. Since the introduction of innovative drugs (the so called ‘new drugs’ and ‘newer drugs’), autologous haemopoietic cell transplantations, and the innovative technique of light chain removal, myeloma outcomes have clearly improved. Impressive advances have been also achieved in understanding, preventing, and treating myeloma renal complications. This review article reassesses, with extreme clarity, all these findings describing the most frequent manifestations associated with multiple myeloma: myeloma cast neuropathy, AL amyloidosis, and monoclonal immunoglobulins deposition disease, focussing on pathogenesis, mechanism, and therapeutic opportunities. Dr Emanuele Angelucci

*Joana Gameiro, Sofia Jorge, José António Lopes

Service of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
*Correspondence to joana.estrelagameiro@gmail.com

Disclosure: The authors have declared no conflicts of interest.
Received: 02.03.17 Accepted: 07.08.17
Citation: EMJ. 2017;2[3]:46-52.

Abstract

Multiple myeloma (MM) is a plasma cell disorder that represents almost 10% of haematologic malignancies. Renal impairment, one of the most common complications of MM that occurs in 20–50% of patients, can present in a variety of forms and is associated with increased mortality. Myeloma cast nephropathy is the most common cause of kidney disease in MM patients, presenting as acute kidney injury in the majority of patients. The recent introduction of new chemotherapy agents, autologous stem cell transplantation, and the development of novel techniques of light chain removal have been associated with improved renal and patient outcomes in MM patients. Nevertheless, dialysis-dependent patients with MM have higher mortality than other dialysis patients and may be considered for kidney transplantation only if sustained remission has been achieved and sustained for at least 3 years, bearing in mind the risk of disease recurrence.

The authors review the most frequent renal manifestations associated with MM, namely myeloma cast nephropathy, light-chain amyloidosis, and monoclonal immunoglobulin deposition disease, focussing on the therapeutic options for acute and chronic kidney disease.

This article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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