Myeloma Kidney Flashcards
What is myeloma?
Cancer of the plasma cells
What is the process of cast nephropathy?
Light chains filtered by glomeruli
Light chains bind to Tamm-Horsfall protein and precipitate in proximal tubules
→ Obstruction → Tubular Rupture and release of light chain into interstitium → Giant cell reaction
What is Fanconi’s syndrome?
Proximal Tubular Dysfunction - malabsoroption of glucose, amino acids, uric acid, phosphate and bicarbonate
How can you get hyperuricaemia with Myeloma?
Neoplastic cell lysis, after chemotherapy
What happens to the bones in myeloma?
Lytic bone lesions due to ↑osteoclastic activity → Hypercalcaemia
What is the most typical presenting complaint of Myeloma?
“Pale, with back pain”
Pale = Pallor due to anaemia
Bone pain (+ weight loss)
What would the investigations show for myeloma kidney?
Renal Failure
Anaemia
Hypercalcaemia
Low platelets
How is myeloma kidney diagnosed?
Clinical Picture
Serum protein electrophoresis: Gamma component antibody peaks
Bone marrow
What is the treatment for myeloma kidney?
Hyperuricaemia - Xanthine oxidase inhibitors/urate oxidase
Hypovolaemia - fluid replacement
Hypercalcaemia - IV fluid, bisphosphonates (inhibit osteoclasts)
Hyperviscosity - IV fluid, plasma exchange
How do you manage cast nephropathy?
Reduce level of circulating light chains - IV fluid + plasma exchange
Reduce production of light chains - Steroids + chemotherapy
