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Clinical features, evaluation, and diagnosis of kidney disease in multiple myeloma and other monoclonal gammopathies

Authors
Gerald B Appel, MD
Nelson Leung, MD
S Vincent Rajkumar, MD
Section Editors
Richard J Glassock, MD, MACP
Robert A Kyle, MD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Kidney disease is a common complication of monoclonal gammopathies (paraproteinemias or dysproteinemias) including multiple myeloma. A wide range of renal manifestations and pathologies involving different mechanisms have been described with these disorders.

This topic provides a review of the clinical features, evaluation, and diagnosis of kidney disease in patients with multiple myeloma and other monoclonal gammopathies. The epidemiology, pathogenesis, etiology, treatment, and prognosis of kidney diseases associated with multiple myeloma and other monoclonal gammopathies are discussed separately. (See "Epidemiology, pathogenesis, and etiology of kidney disease in multiple myeloma and other monoclonal gammopathies" and "Pathogenesis of immunoglobulin light chain (AL) amyloidosis and light and heavy chain deposition diseases" and "Treatment and prognosis of kidney disease in multiple myeloma and other monoclonal gammopathies".)

CLINICAL FEATURES

Patients with multiple myeloma and other monoclonal gammopathies can present with a variety of kidney manifestations that depend upon the pathologic monoclonal proteins involved and the compartments of the kidney that are targeted. The most common clinical findings include:

Acute or subacute kidney injury – Approximately 20 to 50 percent of patients with multiple myeloma present with an elevated serum creatinine at the time of diagnosis [1-5]. The spectrum of kidney impairment ranges from mild injury that may be rapidly reversible (eg, volume depletion, hypercalcemia) to severe acute kidney injury (AKI) requiring hemodialysis (eg, light chain cast nephropathy). Most patients presenting with AKI have light chain cast nephropathy, although other common causes include hypercalcemia and exposure to nephrotoxic agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or, infrequently, radiocontrast agents. (See 'Differential diagnosis' below.)

Chronic kidney disease (CKD) – Some patients with multiple myeloma may experience a gradual or progressive increase in serum creatinine over a period of six months or more. These patients are less likely to have a diagnosis of light chain cast nephropathy. However, patients who have experienced one or more prior episodes of light chain cast nephropathy without complete renal recovery can develop CKD. CKD as a presenting clinical feature is more commonly seen in patients with immunoglobulin light chain (AL) amyloidosis or monoclonal immunoglobulin deposition disease (MIDD). Other factors unrelated to multiple myeloma may also contribute to CKD in patients with multiple myeloma, particularly in those with a prior history of hypertension or diabetes mellitus. (See "Diagnostic approach to the patient with newly identified chronic kidney disease".)

             

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Literature review current through: Aug 2016. | This topic last updated: Sep 7, 2016.
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