Renal Failure in Multiple Myeloma

Posted by e-Medical PPT
Basic Concepts of Renal Failure
“When 75-80% of renal function is lost, the kidneys lose their ability to regulate the internal environment and all organ systems and physiologic processes are affected by renal failure”
“Uremia or the uremic syndrome refers to the constellation of signs, symptoms and physicochemical changes that occur with either acute or chronic renal failure.”

Some Uremic Changes:
Fluid – electrolytes imbalances
 fluid retention causing edema in legs, abdomen, and face
 hyperkalemia, hypocalcaemia, hyperphosphatemia
Changes in cardiovascular system
 Includes the RAAS due to decrease in renin production interrupting feedback loop
Changes in inflammatory –immune response
 Altered T-cell function
 Altered B-cell number and function
Accumulation of toxins
 Uric acid   
 Beta 2 microglobulin

What is Myeloma?
Overproduction of  a single immunoglobulin by cancerous plasma cells
Immunoglobulin is “a protein  produced by body’s immune system to help fight infections”
Normally the body make many different types of immunoglobulins (polyclonal)
In Myeloma  the cancerous cells are monoclonal and are usually of no use to the body
These cells are called M-protein and can be detected in urine.
Research is being done to look at the various reasons for  these changes – especially at certain genetic variations  (such as Chromosome 13 deletion)

Renal Failure in Myeloma
Mechanism of inflammation and damage
Light chain cast deposition – tubule obstruction (“myeloma kidney”) by protein deposits
Obstruction of tubules by plasmacytoma
Hypercalcemia, hyperuricemia: both of which can cause inflammation in the tubules due to high concentrations
Renal amyloid: can cause obstruction which will cause inflammation in the glomerulus
Recurrent pyelonephritis chronic recurrent infections that lead to chronic inflammation of the basement membrane of the nephron tubule
May develop RTA2 (Fanconi syndrome)

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