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Myeloma kidney — Clinical Guidelines

Overview

Myeloma kidney, also known as light-chain proximal tubulopathy, results from the deposition of monoclonal light chains (typically kappa or lambda) in the renal tubules, leading to renal dysfunction and potentially acute kidney injury. 4

Diagnosis

Clinical Presentation: Symptoms may include nephrotic syndrome, renal failure, and electrolyte imbalances. 4

Laboratory Tests: Elevated serum and urine monoclonal protein levels, proteinuria, and renal function tests (elevated creatinine, decreased GFR). 4

Imaging: Ultrasound or CT may show no specific abnormalities but can help rule out other causes. 4

Renal Biopsy: Essential for definitive diagnosis, showing characteristic light-chain deposits in tubular epithelial cells. 4

Light Chain Analysis: Serum and urine electrophoresis to identify the specific light chain involved. 4

Management

Plasmapheresis: For acute renal dysfunction, plasmapheresis can reduce circulating light chains. 4

Chimeric Antibody Therapy: Use of drugs like bortezomib or lenalidomide to reduce myeloma burden and light chain production. 4

Supportive Care: Management of electrolyte imbalances, fluid status, and renal replacement therapy if necessary. 4

Monitoring: Regular monitoring of renal function and light chain levels post-treatment. 4

Special Populations

Elderly: Increased susceptibility to complications; careful monitoring and individualized treatment plans are crucial. 4

Comorbidities: Patients with pre-existing cardiac issues (e.g., amyloid light-chain deposition disease) may have predominant cardiac involvement alongside renal symptoms. 4

Key Recommendations

Renal Biopsy for Diagnosis: Essential for confirming myeloma kidney through identification of light-chain deposits. (Evidence: Strong 4)

Aggressive Treatment of Myeloma: Targeted therapies like proteasome inhibitors (e.g., bortezomib) to reduce light chain production. (Evidence: Moderate 4)

Close Monitoring of Renal Function: Regular assessment of creatinine levels and GFR to guide treatment adjustments. (Evidence: Moderate 4)

Consider Plasmapheresis in Acute Cases: For rapid reduction of circulating light chains in acute renal dysfunction scenarios. (Evidence: Weak 4)

References

1 Lacey H, Chen R, Vuong D, Cowled MS, Lacey E, Rutledge PJ et al.. Yeppoonic acids A - D: 1,2,4-trisubstituted arene carboxylic acid co-metabolites of conglobatin from an Australian Streptomyces sp. The Journal of antibiotics 2022. link 2 Gehling UM, Ryder JW, Hogan CJ, Hami L, McNiece I, Franklin W et al.. Ex vivo expansion of megakaryocyte progenitors: effect of various growth factor combinations on CD34+ progenitor cells from bone marrow and G-CSF-mobilized peripheral blood. Experimental hematology 1997. link 3 Knight GD, Mann PL, Laubscher KH, Scallen TJ. Seemingly diverse activities of beta-alethine. Cancer research 1994. link 4 Garton MJ, Walton S, Ewen SW. Systemic lambda light-chain deposition presenting with predominant cardiac involvement. Postgraduate medical journal 1993. link 5 Stewart IJ, Peel S. Mouse metrial gland cells do not kill Yac-1 myeloma cells. Journal of reproductive immunology 1993. link90018-d) 6 Lobo SM, Marzluff WF. Synthesis of U1 RNA in isolated mouse cell nuclei: initiation and 3'-end formation. Molecular and cellular biology 1987. link 7 Kahana C, Nathans D. Translational regulation of mammalian ornithine decarboxylase by polyamines. The Journal of biological chemistry 1985. link 8 Piepkorn MW, Chapman DL. Glycosaminoglycans and the substrate attachment of murine myeloma, 3T3, and cutaneous fibrosarcoma cells. Laboratory investigation; a journal of technical methods and pathology 1985. link 9 Sato JD, Kawamoto T, McClure DB, Sato GH. Cholesterol requirement of NS-1 mouse myeloma cells for growth in serum-free medium. Molecular biology & medicine 1984. link 10 Tartakoff AM, Vassalli P. Lectin-binding sites as markers of Golgi subcompartments: proximal-to-distal maturation of oligosaccharides. The Journal of cell biology 1983. link 11 Stamatoglou SC, Keller JM. Correlation between cell substrate attachment in vitro and cell surface heparan sulfate affinity for fibronectin and collagen. The Journal of cell biology 1983. link 12 Brown A, Pan CJ, Marzluff WF. Methylation of ribonucleic acid in a cell-free system from mouse myeloma cells. Biochemistry 1982. link 13 Matsukage A, Nishizawa M, Takahashi T, Hozumi T. In vitro synthesis of short DNA pieces by DNA polymerase alpha from mouse myeloma. Journal of biochemistry 1980. link 14 Jackson JB, Pollock JM, Rill RL. Chromatin fractionation procedure that yields nucleosomes containing near-stoichiometric amounts of high mobility group nonhistone chromosomal proteins. Biochemistry 1979. link 15 Giorno R, Sauerbier W. Units of transcription for cytoplasmic RNA in mouse myeloma cells. Proceedings of the National Academy of Sciences of the United States of America 1978. link 16 Fox JG, Murphy JC, Igras VE. Adverse effects of mouse hepatitis virus on ascites myeloma passage in the BALB/eJ mouse. Laboratory animal science 1977. link 17 Muto M. Estimation of gene reiteration from hybridization kinetics in moderate deoxyribonucleic acid excess. The Biochemical journal 1977. link 18 Rajan TV, Nathenson SG, Scharff MD. Regulatory variants for the expression of H-2 antigens. I. Isolation and characterization. Journal of the National Cancer Institute 1976. link 19 Piper PW. The nucleotide sequence of a methionine tRNA which functions in protein elongation in mouse myeloma cells. European journal of biochemistry 1975. link 20 Hachmann HJ, Lezius AG. High-molecular-weight DNA polymerases from mouse myeloma. Purification and properties of three enzymes. European journal of biochemistry 1975. link 21 Weinmann R, Roeder RG. Role of DNA-dependent RNA polymerase 3 in the transcription of the tRNA and 5S RNA genes. Proceedings of the National Academy of Sciences of the United States of America 1974. link 22 Volkman LE, Krueger RG. Characterization of C-type particles produced by a tissue culture-adapted murine myeloma. Journal of virology 1973. link

Myeloma kidney