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Renal impairment in multiple myeloma

Renal impairment is one of the most common complications of multiple myeloma.

Renal impairment at diagnosis of multiple myeloma ranges from 20-50%, according to the definition of renal impairment.

RI associated with poor median survival of approximately 2 years in the era of conventional chemotherapy.

Present use of novel agents in myeloma has resulted in substantial increase in survival of patients with RI, although severe RI is still associated with increased risk of early death.

RI is caused mainly by the toxic effects of the monoclonal light chains on basement membranes of the glomeruli and or the renal tubule.

The most common cause of renal in myeloma is cast nephropathy, which leads to acute kidney injury.

Cast nephropathy develops when light chain production overcomes the capacity of tubular cells to endocytose and catbolize filtered free light chains.

Excess light chains form aggregates and casts with uromodulin in the distal nephron. leading to tubular obstruction and concomitant inflammation.

Hypercalcemia, dehydration, nephrotoxic drugs and contrast agent as continued to the development of or exacerbate existing RI by aggravating the toxic effects of light chains.

Other renal pathological processes including monoclonal immunoglobulin deposition disease, amyloidosis, kidney infiltration by myeloma cells and acquired adult Fanconi syndrome

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