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Acute renal failure in multiple myeloma.

R A Defronzo, R L Humphrey, J R Wright

    Medicine
    |May 1, 1975
    PubMed
    Summary

    Hypercalcemia is a primary cause of acute kidney injury in multiple myeloma patients, unlike previous reports focusing on IVP. Prompt management of hypercalcemia and volume depletion is crucial for poor prognosis in these patients.

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    Area of Science:

    • Nephrology
    • Oncology
    • Internal Medicine

    Background:

    • Multiple myeloma is a plasma cell malignancy.
    • Acute kidney injury (AKI) is a serious complication in multiple myeloma.
    • Previous studies identified intravenous pyelography and dehydration as key AKI factors.

    Purpose of the Study:

    • To review clinical, laboratory, and histologic features of AKI in multiple myeloma.
    • To identify the primary etiologic factors of AKI in a new cohort.
    • To contrast findings with previously reported cases.

    Main Methods:

    • Retrospective review of 14 multiple myeloma patients with AKI.
    • Analysis of clinical manifestations, laboratory data, and renal histology.
    • Comparison with 29 previously reported cases.

    Main Results:

    • Hypercalcemia was the most common cause of AKI (7/14 patients).
    • Nephrotoxic antibiotics (3/14) and volume depletion (2/14) were other factors.
    • Bence Jones proteinuria may increase susceptibility to renal injury.
    • Intravenous pyelography implicated in only one patient.

    Conclusions:

    • Hypercalcemia is a critical, often overlooked, cause of AKI in multiple myeloma.
    • Bence Jones protein may contribute to renal tubule damage.
    • The prognosis for multiple myeloma patients with AKI is poor.
    • Preventive strategies focusing on hypercalcemia and volume status are essential.

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