Kidney and multiple myeloma

Multiple myeloma (MM) is a type of neoplasm in the blood and more specifically of plasma cells, the cells of the organism that normally produce the antibodies in our body used for its defense. In patients with MM, these cells do not function properly, do not produce normal antibodies but continuously produce large amounts of a similar protein.

  • How does it impact my health?
  • Large amounts of this "abnormal" protein enters the bloodstream and is deposited in various organs (e.g. the kidney) creating functional problems. Moreover, they are also responsible for increased infections and bone damage (since the bone marrow hosts the plasma cells).
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  • What are the symptoms of ΜM and how is the diagnosis made?
  • Symptoms are general, non-specific, such as malaise, anorexia, low fever, weight loss. Often patients with MM have bone pain (because of bone involvement), anemia, low white blood cells. The diagnosis is made by determining pathological proteins in blood and / or urine. The final diagnosis of MM is determined by the discovery of pathological bone marrow cells in the bone marrow, meaning the histologic examination of the basic hematopoietic organ.
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  • Is the kidney related to ΜM?
  • Yes, it can be one of the target organs of MM and can affect all its parts – glomeruli (filters), tubules and the kidney tissue directly. Often kidney involvement from MM shows renal insufficiency. When diagnosed with MM, approximately 20% of the patients already have developed some type of renal failure.
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  • How exactly does MM harm the kidney?
  • The enormous amounts of pathological proteins produced in patients with MM are also filtered from the glomeruli and they pass to the tubes. Due to their large quantity, they accumulate and block the smooth flow of "urine" through these tubes, which gradually leads to kidney failure. This lesion is called myelomatous kidney. The other form of kidney damage from MM is the inflammation around the tubules and kidney tissue created only by the presence (without obstruction) of these abnormal proteins in the kidney.
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  • Are there other disorders that can cause kidney problems?
  • Yes. Often MM is accompanied by elevated calcium. Increase in calcium may lead to kidney failure.
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  • Is there any therapy for renal insufficiency caused by MM?
  • The involvement of the kidney as well indicates a more severe disease. If the patient is treated for MM and responds well to the treatment, then renal failure can be improved completely (depending on the time taken until the diagnosis of MM). Even severe kidney damage, requiring hemodialysis, can be improved to such an extent and as a result the patient can eventually discontinue hemodialysis.
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  • I suffer from MM. How should I take care of my kidneys?
  • You are advised to:
  • • be well hydrated constantly (about 2-3 liters per day - unless otherwise advised by your doctor)
  • • avoid taking non-steroidal anti-inflammatory drugs
  • • avoid administering contrast agents if it is unnecessary 
  • • control your blood calcium
  • • take diuretics only when you doctor recommends you toMesogeios Dialysis Centers Group Scientific Team
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  • Bibliography
  • 1.Gavriatopoulou M, Terpos E, Kastritis E, Dimopoulos MA. Current treatments for renal failure due to multiple myeloma. Expert Opin Pharmacother. 2016 Nov;17(16):2165-2177. Epub 2016 Sep 27. Review. PubMed PMID: 27646819.
  • 2.Wanchoo R, Abudayyeh A, Doshi M, Edeani A, Glezerman IG, Monga D, Rosner M, Jhaveri KD. Renal Toxicities of Novel Agents Used for Treatment of Multiple Myeloma. Clin J Am Soc Nephrol. 2017 Jan 6;12(1):176-189. doi: 10.2215/CJN.06100616. Epub 2016 Sep 21. Review. PubMed PMID: 27654928; PubMed Central PMCID: PMC5220662.
  • 3.Yadav P, Cook M, Cockwell P. Current Trends of Renal Impairment in Multiple Myeloma. Kidney Dis (Basel). 2016 Mar;1(4):241-57. doi: 10.1159/000442511. Epub 2016 Feb 3. Review. PubMed PMID: 27536684; PubMed Central PMCID: PMC4934811.
  • 4.Fotiou D, Dimopoulos MA, Kastritis E. Managing renal complications in multiple myeloma. Expert Rev Hematol. 2016 Sep;9(9):839-50. doi: 10.1080/17474086.2016.1210003. Epub 2016 Jul 22. Review. PubMed PMID: 27426872.
  • 5.Radojevic-Skodric S, Bogdanovic L, Jovanovic M, Baralic I, Dzamic Z, Gordon R, Ognjanovic S, Basta-Jovanovic G. Acute Renal Failure in Different Malignant Tumors. Curr Med Chem. 2016;23(19):2041-6. Review. PubMed PMID: 27052184.
  • 6.Vadlamudi S, Annapareddy SN. Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease. Saudi J Kidney Dis Transpl. 2016 Jan;27(1):9-14. doi: 10.4103/1319-2442.174046. Review. PubMed PMID:
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  • 7.Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP, Picken MM,  Herrera GA, Kastritis E, Merlini G, Roussel M, Fervenza FC, Dispenzieri A, Kyle RA, Nasr SH; International Kidney and Monoclonal Gammopathy Research Group. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015 Apr;87(4):698-711. doi: 10.1038/ki.2014.408. Epub 2015 Jan 21. Review. PubMed PMID: 25607108.
  • 8.Gozzetti A, Papini G, Candi V, Bocchia M. Evolving treatments in multiple myeloma patients with renal failure. Rev Recent Clin Trials. 2014;9(4):276-9. Review. PubMed PMID: 25329484.
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