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[Renal failure in multiple myeloma: Specific management issues].

Mélanie Try¹, Stéphanie Harel²

¹Centre hospitalier universitaire de Bicêtre, assistance publique-hôpitaux de Paris (APHP), université Paris-Saclay, service de néphrologie, dialyse et transplantation, 94270 Le Kremlin-Bicêtre, France; Groupe de Recherche Interdisciplinaire Francophone en Onco-Néphrologie, Paris, France.

Bulletin Du Cancer

|February 9, 2023

Summary

Multiple myeloma frequently causes kidney impairment, primarily through cast nephropathy. Early intervention with chemotherapy and supportive care can improve kidney function and patient outcomes.

Keywords:

Acute renal failure Chemotherapy Chimiothérapie Chronic kidney disease High-cutoff or high flux hemodialysis Hémodialyse à membranes high-cut-off ou high flux Insuffisance rénale aiguë Insuffisance rénale chronique Multiple myeloma Myeloma cast nephropathy Myélome multiple Néphropathie à cylindres myélomateux

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Area of Science:

Nephrology
Hematology
Oncology

Context:

Renal impairment is a frequent complication of multiple myeloma, significantly impacting patient prognosis.
Cast nephropathy, resulting from monoclonal free light chain precipitation, is the leading cause of acute kidney injury in this condition.
Kidney biopsy aids in assessing renal prognosis based on cast formation, tubular atrophy, and interstitial fibrosis.

Purpose:

To outline the pathophysiology of renal impairment in multiple myeloma.
To detail diagnostic considerations and prognostic indicators for kidney involvement.
To review current and emerging therapeutic strategies for managing renal complications.

Summary:

Acute kidney injury in multiple myeloma is mainly caused by cast nephropathy, involving monoclonal free light chains and uromodulin.
Management strategies include rehydration, avoiding nephrotoxic agents, and anti-plasma cell chemotherapy to reduce light chain toxicity.
Reference treatment for newly diagnosed patients with renal impairment involves Bortezomib and Dexamethasone, with potential additions of Cyclophosphamide or Lenalidomide.
Hemodialysis and kidney transplantation are options for patients with chronic kidney disease or end-stage renal disease.

Impact:

Early diagnosis and intervention are crucial to prevent progression to chronic kidney disease.
Optimized management strategies can improve renal function recovery and overall survival in multiple myeloma patients.
Close collaboration between hematologists and nephrologists is essential for comprehensive patient care.