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[Maintenance hemodialysis in IgD- lambda -type multiple myeloma associated with severe renal failure]
1Second Department of Internal Medicine, Yokohama Minami-Kyousai Hospital, Japan.
Nihon Jinzo Gakkai Shi
|February 1, 1994
Summary
This case study highlights aggressive treatment for multiple myeloma with renal failure, including dialysis and chemotherapy. It suggests these interventions can improve outcomes despite complications like pneumonia.
Area of Science:
- Nephrology
- Oncology
- Hematology
Background:
- Multiple myeloma can cause significant renal failure.
- The role of maintenance dialysis in myelomatosis remains debated.
Observation:
- A 52-year-old man presented with severe oliguric renal failure due to multiple myeloma.
- Treatment included hemodialysis, chemotherapy (prednisolone, melphalan), and double filtration plasmapheresis (DFPP).
- The patient experienced complications including MRSA pneumonia, treated successfully with antibiotics and G-CSF.
Findings:
- Bone marrow biopsy confirmed multiple myeloma with atypical plasma cell infiltration.
- Renal biopsy showed myeloma kidney.
- Immunoelectrophoresis revealed lambda-type Bence Jones protein and IgD-lambda M protein.
- DFPP reduced serum IgD levels significantly.
Implications:
- Aggressive treatment, including chronic dialysis, chemotherapy, and plasma exchange, may be beneficial for myeloma patients with established renal failure.
- This approach can potentially improve quality of life and manage complications.
- Despite aggressive treatment, long-term complications like peripheral neuropathy and cardiac arrhythmia can occur.