There has been much recent interest in novel extra-corporeal treatments for removal of nephrotoxic free light chains (FLC) in myeloma cast nephropathy. HCO dialyzers employ high flux membranes with particularly large pores (up to 50kDa Vs 15kDa for…
There are a laundry list of renal complications in multiple myeloma that have been previous reviewed on RFN. Myeloma cast nephropathy is one of the most frequent, being found in approximately a third of patients in autopsy series….
A middle aged man with IgG kappa multiple myeloma previously treated with bortezomib and lenalidomide presented to the hospital with altered mental status. He had completed chemotherapy months prior to presentation. Shortly after being admitted, he progressed to…
Multiple myeloma (MM) is the most common malignancy causing ESRD. Renal disease is frequently related to the characteristics of the monoclonal immunoglobulin produced, which can lead to 3 general pathological findings: “cast nephropathy’, light chain deposition disease or…
We were recently consulted on a patient with a history of multiple myeloma who had developed severe hypercalcemia and acute renal failure. The calcium on admission was 15mg/dl (albumin 2.6) and the patient was treated aggressively with IV…
I recently saw a biopsy for a patient who was suspected of having myeloma-related kidney disease, whose biopsy slides were sent to the pathology department at BWH. Along with them came results from a slew of screening tests,…
There was an interesting case report in KI earlier this year. It concerned a 69yr old man with a history of benign prostatic hyperplasia and Waldenstrom’s Macroglobulinemia (WM) who was admitted for the workup of renal failure. His…
Monoclonal gammopathies generally arise from an abnormal clone that has developed from a single cell of B-cell lineage. The monoclonal protein can be intact immunoglogulin (often associated with free light chain), free light chain (FLC) in isolation, or…
Bortezomib is a proteosome inhibitor used primarily in the treatment of relapsed myeloma. However, it is increasingly being used in the management of myeloma cast nephropathy (MCN). Bortezomib binds to, and inhibits the function of, the 26S proteosome…
Cancer-associated hypercalcemia is the #1 cause for hypercalcemia in the inpatient setting (in the outpatient setting, the main cause is primary hyperparathyroidism). In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by…
