Abstract
Multiple myeloma (MM) has a high incidence rate in the elderly. Responsiveness to treatments differs considerably among patients because of high heterogeneity of MM. Chronic kidney disease (CKD) is a common clinical feature in MM patients, and treatment-related mortality and morbidity are higher in MM patients with CKD than in patients with normal renal function. Recent advances in diagnostic tests, chemotherapy agents, and dialysis techniques are providing clinicians with novel approaches for the management of MM patients with CKD. Once reversible factors, such as hypercalcemia, have been corrected, the most common cause of severe acute kidney injury (AKI) in MM patients is tubulointerstitial nephropathy, which results from very high circulating concentrations of monoclonal immunoglobulin free light chains (FLC). In the setting of AKI, an early reduction of serum FLC concentration is related to kidney function recovery. The combination of extended high cutoff hemodialysis and chemotherapy results in sustained reductions in serum FLC concentration in the majority of patients and a high rate of independence from dialysis.
Highlights
Kidney dysfunction is a worldwide public health problem with an increasing incidence and prevalence, and it is associated with high costs and relatively poor outcomes [1]
We focus on the clinical management of the kidney dysfunction associated with MM
Serum free light chains (FLC) concentrations should be considered in MM patients with acute kidney injury (AKI)
Summary
Kidney dysfunction is a worldwide public health problem with an increasing incidence and prevalence, and it is associated with high costs and relatively poor outcomes [1]. It is possible to reverse kidney dysfunction in approximately 50% patients, but the remaining patients will have some degree of persistent chronic kidney disease (CKD); and of these, 2%–12% will require renal replacement therapy (RRT) [7]. Kidney dysfunction in MM may result from various factors, and in most cases it is minor and recovered with infusion solution and correction of serum calcium levels [5, 6], though occasionally the condition may become exacerbated. Both acute kidney injury (AKI) and progressive CKD can result in end-stage renal disease (ESRD). We focus on the clinical management of the kidney dysfunction associated with MM
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