Renal failure and multiple myeloma: pathogenesis and treatment of renal failure and management of underlying myeloma

Renal impairment is a common complication of multiple myeloma occurring in 50% of patients at some stage in their disease. Pathogenesis is multifactor ial, Nephrotoxic manifestations of monoclonal immunoglobulin overexpression include the 'myeloma kidney', light chain deposition disease, AL amyloid, plasma cell infiltration and glomerulonephritis. Other factors, such as hyp ercalcaemia, hyperuricaemia, infection, hyperviscocity and nephrotoxic drug s can precipitate or exacerbate acute and chronic renal failure. Aggressive treatment has dramatically improved outcome in patients who present with a cute or acute-on-chronic renal failure. Dialysis has become an accepted tre atment acutely and in end stage renal disease due to myeloma. Conventional therapy with melphalan and prednisolone is still advocated for elderly pati ents. However, renal failure is not a contraindication to aggressive cytore duction, stem cell collection, double hemibody radiotherapy and autologous transplantation in those otherwise fit to tolerate these procedures, Progno sis is primarily determined by the response of the myeloma clone to chemoth erapy, Outcome in chemosensitive patients approaches that of patients with equivalent disease stage without renal dysfunction.