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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2016  |  Volume : 27  |  Issue : 1  |  Page : 9-14
Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease


Department of Nephrology, NRI Medical College, Chinakakani, Guntur District, Andhra Pradesh, India

Correspondence Address:
Srilatha Vadlamudi
Department of Nephrology, NRI Medical College, Chinakakani, Guntur District - 522 503, Andhra Pradesh
India
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DOI: 10.4103/1319-2442.174046

PMID: 26787560

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Multiple myeloma is one of the most common malignancies encountered in clinical practice. Renal involvement in myeloma is a well-recognized entity. Although rare, another special situation that a nephrologist can encounter is myeloma occurring in a patient with preexisting chronic kidney disease (CKD) due to other etiologies. Anemia, bone pains and hypercalcemia, which commonly indicate the diagnosis of myeloma in the general population, are not useful in the presence of CKD. The sensitivity and specificity of serum free light chain assay is decreased in the presence of renal failure. Chemotherapy-related adverse effects are high compared with that in patients without CKD; this is attributed to the decreased clearance of drugs and the additive effect of chemotherapy-related adverse effects to the complications of CKD. Autologous and allogenic bone marrow transplantation can be attempted in this group of patients with non-myeloablative-conditioning regimens. Combined bone marrow and renal transplantation remains a viable option in this group of patients to increase life expectancy and quality of life.


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