Myeloma and the kidneys

Question 1

What is multiple myeloma?

Answer 1

plasma cell disorder causing an increase in levels of certain immunoglobulins at the expense of other blood cell types, eg platelets and RBC

Question 2

How does multiple myeloma affect the kidneys?

Answer 2

Light chains block PCT and cause inflammation and obstruction

Question 3

What are the symptoms of myeloma

Answer 3

Bone pain (Increased OC activity)

Anaemia

WL

Hyperviscosity symptoms due to protein in te blood - headache, papilloedema and visual problems, hypertension, convulsions

Question 4

How do you diagnose myeloma?

Answer 4

Protein electrophoresis

Bone marrow biospy

Punched out lesions on x ray

Question 5

What factors predispose MM patients to AKI?

Answer 5

Hyperuriciema from chemo (manage this)

Hypercalcaemia from bone damage

NSAIDS

IV contrast

Infection

Question 6

How do you manage AKI from myeloma?

Answer 6

Treat hyperuricaemia - xanthase oxidase inhibitors

Treat hypercalcaemua - Increase urine output/bisphosphonates

Treat hyperviscosity - fluid

Treat hyperkalaemia - insulin and glucose