Myeloma Flashcards
1
Q
what is it?
A
dysproteinaemia - overproduction of immunoglobulin (a protein) by clonal expansion of cells from B cell lineage
2
Q
what is the pathology
A
cancer of plasma cells - normally producing antibodies
collections of abnormal plasma cells accumulate in the bone marrow
impairment of production of normal blood cells
monoclonal production of paraparotein (abnormal Ab) - potentially cause renal dysfunction
3
Q
how does it present?
A
bone pain weakness fatigue weight loss recurrent infections anaemia hypercalcaemia renal failure lytic bone lesions classical presentation - backpain and renal failure
4
Q
renal manifestations of myeloma?
A
20-40% present with renal impairment
mulit-factor aetiology
glomerular - AL amyloidosis, monoclonal immunoglobulin deposition (light/heavy chain)
tubular - light chain cast nephropathy
miscellaneous - dehydration/hypercalcaemia/contrast/bisphosphonates/NSAID
5
Q
investigation
A
high index of suspicion bloods: serum protein electrophoresis, serum free ligh chains urine: Bence Jones protein bone marrow biopsy skeletal survey renal biopsy
6
Q
how is it managed?
A
stop nephrotoxics manage hypercalcaemia (saline +/- bisphsphonates) chemotherapy + stem cell transplant plasma exchange - remove light chains supportive - dialysis
