Search
myeloma cast nephropathy
Etiology:
- multiple myeloma
Epidemiology:
- 20% of patients with multiple myeloma
Pathology:
- Ig light chains
- renal tubular injury
- obstructive uropathy of tubular origin
Laboratory:
- 24 hour urine protein
- urine dipstick detects albumin, not Ig light chains
- serum protein electrophoresis
- high serum free light chains
- urine protein electrophoresis
- immunofixation electrophoresis
Management:
- treatment of multiple myeloma
- reduce free Ig light chains with chemtherapy
- avoid bisphosphonates
- pamidronate may induce acute renal failure & nephrotic syndrome
- zoledronate may induce acute tubular necrosis
- contraindicated if GFR > 30 mL/min
- avoid NSAIDs, especially in patients with volume depletion
Related
multiple myeloma; plasmacytoma/plasma cell myeloma
General
nephropathy
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18, 19.
American College of Physicians, Philadelphia 2009, 2012, 2018, 2021.