What is the most common cause of renal failure in newly diagnosed patients with multiple myeloma?

Clinical Pearls Podcasts published on May 22, 2017
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Ruben Niesvizky, MD
Professor of Medicine
Weill Cornell Medical College
Director
Multiple Myeloma Center and Oncology Operations
New York Presbyterian Hospital/Weill Cornell Medicine
New York, New York

What is the most common cause of renal failure in newly diagnosed patients with multiple myeloma?
  1. About 20% of myeloma patients have renal failure
    1. One of the most common and severe problems in multiple myeloma (MM)
  2. Combined etiology, with most common cause apparently related to paraprotein characteristics
    1. 73% of MM patients have a paraprotein-related renal lesion, such as:
      1. Cast nephropathy
      2. Monoclonal immunoglobulin deposition disease
      3. Primary amyloidosis
    2. Most cases have additional complications such as:
      1. Hypotension
      2. Hypercalcemia
      3. Acute tubular necrosis
  3. Management of renal failure should use a combined approach, including:
    1. Hydration
    2. Reduction of all the comorbidities
    3. Initiation of therapy
Last modified: April 14, 2017
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