Multiple Myeloma and Renal Failure: Mechanisms, Diagnosis, and Management

Abstract

Multiple myeloma (MM) is the second most common hematologic malignancy that involves monoclonal immunoglobulin (Ig)-producing plasma cells. Due to its multifaceted clinical manifestations and complications, it draws attention to various medical specialties like neurology, nephrology, orthopedics, cardiology, etc. Renal failure (RF) is one of the most common and most serious complications of MM that can be caused either by excess immunoglobulins that are nephrotoxic or some other causes like hypercalcemia, infection, etc. In this review article, we have discussed the pathogenesis of RF in MM, described the different diagnostic tools to diagnose RF in MM, and explained different treatment modalities to treat RF in MM, including certain general measures (i.e., hydration, withholding any nephrotoxic agents), renal replacement therapy, serum free light chain (SFLC) removal by plasma exchange and high cut-off dialyzer (HCO-HD), chemotherapy, hematopoietic stem cell transplantation (HSCT), and renal transplantation.

Renal insufficiency predicts worse prognosis in newly diagnosed IgD multiple myeloma patients

“…Serum β2-MG is elevated in RF patients ( 1 ). Therefore, the increase in serum β2-MG in MM patients with RF is probably not only due to tumor burden.…”

“…However, when serum free light chains exceed the absorption capacity of the proximal tubule, these will cause damage to the proximal tubule cells. Therefore, the key to treating renal damage is to remove the excessive serum free light chain ( 1 ). European studies have shown that the removal of free light chains by prolonged dialysis has no benefit to patients during the follow-up, although these results might be partly attributed to the different chemotherapy regimens of these patients ( 20 ).…”

“…In this population-based retrospective analysis from March 2018 to November 2021, patients with positive serum IgD M protein were selected in the First Affiliated Hospital of Zhengzhou University. The inclusion criteria were as follows ( 1 ): age of 18–80 years ( 2 ), primary diagnosis of MM, and ( 3 ) positive serum IgD M protein. The exclusion criteria were ( 1 ) incomplete information and ( 2 ) having other primary glomerular diseases.…”

“…The inclusion criteria were as follows ( 1 ): age of 18–80 years ( 2 ), primary diagnosis of MM, and ( 3 ) positive serum IgD M protein. The exclusion criteria were ( 1 ) incomplete information and ( 2 ) having other primary glomerular diseases. Finally, a total of 85 patients were included.…”

“…Multiple myeloma (MM) is a proliferative disease of malignant plasma cells, with its incidence taking the second place among hematological tumors (1)(2)(3). MM can be divided into different classes according to subtypes of secreted immunoglobulins.…”