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Renal complications in multiple myeloma
1Department of Pathology, Albert Szent-Györgyi University of Medicine, Szeged, Hungary.
Insights
Multiple myeloma frequently causes kidney complications, with Bence Jones cast nephropathy being the most common in patients with impaired renal function. Histological changes and renal function showed correlation, but caution is advised when inferring function from morphology.
Area of Science:
- Nephrology
- Oncology
- Pathology
Background:
- Multiple myeloma frequently leads to renal complications.
- Understanding the spectrum of kidney pathology is crucial for patient management.
Purpose of the Study:
- To investigate the types and frequency of renal complications in patients with multiple myeloma.
- To correlate histological findings with renal function.
Main Methods:
- Autopsy-based study of 81 multiple myeloma patients.
- Kidney tissue examination for specific lesions (e.g., Bence Jones cast nephropathy, light chain deposition disease, amyloidosis).
- Grading of lesions and correlation with serum creatinine levels.
Main Results:
- Bence Jones cast nephropathy was the most frequent complication (33%) in patients with impaired renal function.
- Other complications like light chain deposition disease and amyloidosis were less common.
- A good correlation was observed between histological grading and serum creatinine, but exceptions noted.
Conclusions:
- Bence Jones cast nephropathy is a significant cause of renal dysfunction in multiple myeloma.
- Morphological changes in the kidney require careful interpretation regarding functional impairment.
Abstract:
Renal complications were studied in 81 autopsied patients suffering from multiple myeloma (47 male, 34 female, mean age 66.3 years). Kidney samples were examined for the presence of Bence Jones cast nephropathy, light chain deposition disease, amyloidosis, nephrocalcinosis, chronic urate nephropathy, acute renal failure, renal vein thrombosis, acute and chronic pyelonephritis, and tumorous infiltration of the kidney tissue. Lesions were graded under the light microscope as minimal, mild, moderate or severe. This grading and the corresponding serum creatinine levels were used to distinguish four groups: 1. morphologically and functionally intact kidney (40 cases); 2. kidney involvement with good renal function (10 cases); 3. kidney involvement with moderate chronic renal insufficiency (16 cases); 4. kidney involvement with chronic uraemia (15 cases). In patients with an impaired renal function (groups 3 and 4), Bence Jones cast nephropathy occurred most frequently (27 cases, 33%); all other complications were seen much less frequently. Among the 81 patients, two cases of kappa light chain deposition disease and three cases of amyloidosis were found. Although the semiquantitative morphology and serum creatinine levels displayed a good correlation, there were cases with marked histological changes but only a moderate impairment in renal function, suggesting that the drawing of functional conclusions from morphological changes of the kidney requires caution.