Myeloma kidney C 90.0

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

Dieser Artikel auf Deutsch

Synonym(s)

CAST nephropathy; MCN; Myeloma cast nephropathy

Definition
This section has been translated automatically.

The myeloma kidney is a paraproteinemic kidney disease. It is caused by deposits of intact immunoglobulins or immunoglobulin fragments in the renal parenchyma.

Occurrence/Epidemiology
This section has been translated automatically.

30% of all patients with multiple myeloma develop a myeloma kidney (= cast nephropathy)

You might also be interested in

Etiopathogenesis
This section has been translated automatically.

Caused by the myeloma kidney toxic effects of the light chains on the renal tubules through accumulation of the light chains Atrophy of the tubule cells

Clinical features
This section has been translated automatically.

The myeloma kidney may exhibit one or more of the following symptoms:

  • Nephrotic syndrome with proteinuria <3g/24
  • Renal insufficiency with normal sized kidneys and bland urine sediment
  • Night sweat of Bence-Jones proteins and low levels of albumin

Diagnosis
This section has been translated automatically.

Clinic, lab, ultrasound,

Diagnostic confirmation of multiple myeloma

Kidney biopsy to secure the kidney

Complication(s)
This section has been translated automatically.

A myeloma kidney can lead to chronic renal failure requiring dialysis (Favà A et al. 2018).

Therapy
This section has been translated automatically.

Conventional chemotherapy with melphalan (Alkeran®, 15 mg/m² i.v. as bolus day 1) + prednisolone (60 mg/m² p.o. day 1-4), repetition day 29

Polychemotherapy according to VAD protocol (vincristine, adriamycin, dexamethasone) before planned high-dose chemotherapy or in case of insufficient response to melphalan + prednisolone or in renal insufficiency

High-dose chemotherapy (with melphalan) followed by autologous stem cell transplantation

Questionable: High cutoff hemodialysis (HCO-HD). The procedure is suitable for removing large amounts of paraproteins from the blood. The long-term outcome of patients treated in this way is rather disappointing (Hutchison CA et al. 2019).

Aftercare
This section has been translated automatically.

Medical history, physical examination, immunoglobulins quantitatively and Bence-Jones proteins in urine, blood count, calcium, creatinine, bone marrow puncture, X-ray control of osteolytic foci

Literature
This section has been translated automatically.

  • Agrawal P et al (2019) Monoclonal Gammopathy of Renal Significance Triggered by Viral E Hepatitis. Indian J Nephrol 29:50-52.
  • Ashraf M et al (2019) Waldenström Macroglobulinemia: Unusual Presentation With Cast Nephropathy/Light Chain Tubulopathy. Clin Med Insights Case Rep 12:1179547619828704. https://www.ncbi.nlm.nih.gov/pubmed/30799965
  • Favà A et al (2018) Treatment of multiple myeloma with renal involvement: the nephrologist's view. Clin Kidney J 11:777-785. https://www.ncbi.nlm.nih.gov/pubmed/30524711
  • Hutchison CA et al (2019) High cutoff versus high-flux haemodialysis for myeloma cast nephropathy inpatients receiving bortezomib-based chemotherapy (EuLITE): a phase 2 randomised controlled trial.lancet Haematol 6:e217-e228. https://www.ncbi.nlm.nih.gov/pubmed/30872075
  • Kanzaki G et al (2019) Monoclonal Immunoglobulin Deposition Disease and Related Diseases. J Nippon Med Sch 86:2-9.
  • Mukherjee T et al (2019) Cholemic nephrosis (bile cast nephropathy) with severe liver dysfunction. Med J Armed Forces India 75:216-218.
  • Leung N et al (2018) Dysproteinemias and Glomerular Disease. Clin J Am Soc Nephrol 13:128-139.
  • Luan H et al (2019) Cast nephropathy associated with monoclonal immunoglobulin M-secreting mucosa-associated lymphoid tissue B-cell lymphoma.Clin Nephrol doi: 10.5414/CN109682.
  • Sallée M et al (2019) Myeloma cast nephropathy: the dusk of high cutoff haemodialysis. Lancet Haematol 6:e174-e176.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020