Multiple myeloma and kidney failure

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To measure the population ageing expected an increase in cases of dyscrasia of plasma cells and hence kidney failure associated with the paraproteinemia apneic.

At the time of the diagnosis of multiple myeloma, up to 50% of the patients presented some degree of commitment to renal function. Besides the excretion of light chains, there are other factors responsible for the azotaemia as hypercalcaemia, dehydration and nephrotoxic substance use.

The renal compromise is clearly associated with the high tumour mass and is more evident in patients with more advanced stages of the disease. The presence of renal failure does not modify the response of the tumor to chemotherapy and is not a mortality prognostic factor.

95% of patients recover kidney function in the four months following the diagnosis and only 1% requires permanent renal replacement therapy. In the initial management of patients should be deemed the use of plasmapheresis and chemotherapy in high doses seeking to avoid irreversible renal failure.

In those patients with controlled disease and without significant comorbidity must be considered, if necessary, renal replacement therapy including the kidney transplant.

Renal failure in multiple myeloma is frequent It is present in 20-40% of cases at the time of diagnosis, and is a factor of prognosis. Myeloma kidney and hypercalcemia are the most frequent causes other factors that can contribute are dehydration, hyperuricemia, iodinated contrast and nephrotoxic drugs.
kidney failure
Repeated episodes of hypercalcemia can produce deposits of calcium salts in tissues, especially in those with an alkaline medium such as the kidneys, lungs or the gastric mucosa. We present the case of a 38 year-old man with severe hypercalcemia, acute renal failure, multiple myeloma, metastatic and multiorgan failure calcinocis.

Hypercalcemia occurs in multiple myeloma by increase of bone resorption by osteoclast activation due to an overactive receptor RANK/RANK-L. Renal failure occurs due to injury in the renal tubular epithelium that alters the ability to concentrate urine and sometimes cause epithelial cell necrosis and obstruction of the tubules, being able to produce stasis and calcium deposits in the kidney.The treatment must establish quickly with hydration and therapy antimieloma, including steroids.

We conclude on the need to closely monitor the levels of calcium in patients with multiple myeloma and early start therapeutic measures. Bisphosphonates and more effective therapy in renal failure, are recommended in cases of malignant hypercalcemia used the less nephrotoxic adjusted dose.

Symptoms and diagnosis

The main symptom is bone pain, who have 75% of patients. They may appear in any location but the most frequent are beginners in the vertebral column and ribs.

Other possible manifestations of multiple myeloma are the result of the lack of red blood cells (exhaustion, weakness, palpitations, dizziness) or the disruption of the normal functioning of the platelets (easy appearance of hematomas), bleeding from the nose or gums.

In addition, there may be weight loss, frequent infections, bone fractures without an apparent cause and, occasionally, the emergence of real tumors (plasmacytomas) plasma cells.

80% of patients with multiple myeloma have osteoporosis, osteolysis (when worn and reduce one or more areas of a bone), or bone fractures at the time of diagnosis.

The regions affected most frequently are: skull, vertebral column, ribs, sternum, pelvis and long bones such as the femur. A quarter of patients with multiple myeloma has renal failure at the time of diagnosis.

The diagnosis of multiple myeloma is based on the demonstration of an abnormally high amount of a certain immunoglobulin in the blood or urine and an excess of plasma cells in bone marrow.

This must be done different extractions of blood and bone marrow (via puncture of the sternum or bone from the hip and a syringe aspiration). Urine 24 hours to assess whether the above-mentioned abnormal immunoglobulin is present and in which quantities must be tested in the same way.

Finally, all the bones of the skeleton x-rays must be made to see if they have been damaged by the disease. Other analytical changes common in this disease are increased creatinine (renal failure) and plasma calcium, moderate anemia and plaquetopenia.

These findings are not always diagnosed multiple myeloma. Thus patients with a very moderate increase in immunoglobulins and plasma cells in bone marrow, in the absence of any other data of the data mentioned has a Gammapatía Monoclonal of uncertain significance (GMSI), is a minor of myeloma which represents 70% of the monoclonal gammopathies, which usually remain stable for decades without requiring treatment. The probability of transformation of the GMSI myeloma is 12%, 25% and 30% at 10, 20 and 25 years respectively.

Otherwise minor of myeloma is quiescent myeloma. These patients meet criteria for Myeloma (by the increase of immunoglobulins and plasma cells) but have no other clinical or analytical representation of the disease. These patients should not be treated unless there is a progression of disease progression that usually occurs 2-4 years after the diagnosis.

Multiple myeloma with amyloidosis