Pathogenesis of Renal Failure in Multiple Myeloma: Any Role of Contrast Media?

Abstract

The spectrum of kidney disease-associated monoclonal immunoglobulin and plasma cell malignancies is remarkably broad and encompasses nearly all nephropathologic entities. Multiple myeloma with kidney impairment at presentation is a medical emergency since the recovery of kidney function is associated with survival benefits. In most cases, kidney impairment may be the first clinical manifestation of malignant plasma cell dyscrasias like multiple myeloma and light chain amyloidosis. Multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media. The risk is increased by comorbidities such as chronic kidney disease, diabetes, hypercalcemia, dehydration, and use of nephrotoxic drugs. Before the administration of contrast media, the current recommended laboratory tests for assessing kidney function are serum creatinine measurement and the estimation of glomerular filtration rate by using the CKD-EPI equation. The assessment of Bence Jones proteinuria is unnecessary for evaluating the risk of kidney failure in patients with multiple myeloma, since this test cannot be considered a surrogate biomarker of kidney function.

Renal, GI, and Peripheral Nerves: Evidence-Based Recommendations for the Management of Symptoms and Care for Patients With Multiple Myeloma

“…ɐ Healthcare providers must be certain that dehydration is corrected prior to oral or IV iodinated contrast dye for radiologic procedures. The risk of AKI following the use of iodinated contrast dyes is increased in patients with chronic kidney disease, diabetes, malignancy, and heart failure, and in older adults (Moos et al, 2013;Mussap & Merlini, 2014). Bridoux et al, 2016;Chanan-Khan et al, 2007;Dimopoulos, Roussou, et al, 2016;Palumbo et al, 2016;San Miguel et al, 2008;Zanetti et al, 2015;Ziogas et al, 2017 Carfilzomib Newly diagnosed MM; relapsed MM…”

KIM1 and NGAL Expression in Patients with Multiple Myeloma and Clinicopathological Significance

“…Multipl myelom (MM) hastalarının çoğunluğu, geri dönüşü olmayan akut böbrek hasarına sahiptir. Bu durum olumsuz prognozla ilişkilidir (1) . Erken aşamada böbrek disfonksiyonu riski altındaki bireylerin tanınması, kalıcı renal hasarın önlenmesi ve tedavinin zamanında başlatılması için kritik öneme sahiptir (2) .…”

“…Literatürde böbrek hasarı açısından yüksek riskli hastalarda, erken belirleme ve daha sonra doğrulanması için iki taraflı belirleyici olarak kanda ve/veya idrarda NGAL ve KIM1'in kullanılması gerektiği ile ilgili çok sayıda çalışma bulunmaktadır (1,7,13) . Fakat, multipl myelomlu hastaların kemik iliği biyopsisinde, neoplastik plazma hücrelerinde NGAL ve KIM1 ekspresyon varlığı ve prognostik önemine dair bir çalışma bulunmamaktadır.…”

Gammapatie monoklonalne o znaczeniu nerkowym

“…Zmiana ładunku elektrycznego w okolicach regionów zmiennych łańcuchów lekkich, tzw. rejonów determinujących komplementarność (complementaritydetermining region -CDR) indukuje oporność na proteolizę, prowadząc do krystalizacji łańcucha lekkiego [8].…”

“…Obraz w mikroskopie świetlnymZłogi amyloidu przyjmują wygląd bezpostaciowego, bezkomórkowego eozynofilnego materiału zewnątrzkomórkowego, zlokalizowanego najczęściej w kłębuszkach nerkowych, także w ścianie naczyń tętniczych, rzadziej w miąższu nerki. Kryterium diagnostycznym jest zielone zabarwienie złogów w czerwieni Kongo, w świetle spolaryzowanym[6,8] Obraz w badaniu immunofluorescencyjnym W amyloidozie AL -lekki łańcuch lambda, rzadziej kappa. W amyloidozie AH -łańcuch ciężki.…”