#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Kidney damage in multiple myeloma and other monoclonal gammopathies


Authors: Z. Adam 1;  L. Pour 1;  M. Krejčí 1;  S. Štěpánková 2;  I. Svobodová 3;  K. Veselý 3;  R. Hájek 1
Authors‘ workplace: Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc. 1;  Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jan Lata, CSc. 2;  I. patologicko‑anatomický ústav Lékařské fakulty MU a FN u sv. Anny Brno, přednostka doc. MUDr. Markéta Hermanová, CSc. 3
Published in: Vnitř Lék 2008; 54(9): 847-861
Category: Review

Overview

Multiple myeloma typically damages the skeleton in the form of osteolytic lesions or diffuse osteoporosis and causes a decrease in blood production. Renal insufficiency is diagnosed immediately at the onset of illness when establishing diagnosis in up to 20% of patients. Where patients suffer from an advanced form of the illness, it occurs in up to 40%. The predominant cause of damage to the kidneys is the monoclonal light chains. Most frequently, nephropathy is caused by the precipitation of light chains with the Tamm-Horsfall protein in the distal part of the loop of Henle and subsequent tubular ruptures and the creation of fibrous changes in the interstitium. Less frequently, there is clinically serious damage to tubular functions without indication of renal insufficiency. In some patients monoclonal immunoglobulin induces changes in the glomeruli. A rare type of damage is deposits of light chains in the form of AL-amyloid and subsequent nephritic syndrome. A very rare form is the deposition of monoclonal immunoglobulin in the form of amorphous matter (light-chain deposition disease) or in the form of crystals within tissue histiocytes (crystal storing histiocytosis). Both of these disorders cause renal insufficiency and less frequently nephritic syndrome such as AL amyloidosis. With timely and intensive treatment of multiple myeloma, which quickly suppresses the creation of light chains, a significant proportion of patients experience reparative changes and improved kidney function. The benefit of plasmapheresis for patients with severe kidney damage has not been confirmed by randomised studies. At the present time the first positive results are becoming available from tests of the use of pre-emptive haemodialysis with special columns that are permeable for light chains. The aim of the text is to provide information on the various forms of nephropathy whose closer analysis can reveal multiple myeloma and contribute to the timely diagnosis of the cause of the nephropathy.

Key words:
multiple myeloma – myeloma kidney – cast nephropathy – AL-amyloidosis – light-chain deposition disease – crystal storing histiocytosis – bortezomib – thalidomid – plazmaferesis


Sources

1. Adam Z, Krejčí M, Vorlíček J. Přehled maligních krevních chorob. Praha: Grada 2008.

2. Alexanian R, Barlogie B, Dixon D. Renal failure in multiple myeloma. Pathogenesis and prognostic implication. Arch Intern Med 1990; 150: 1693–1695.

3. Iggo N, Palmer ABD, Severn A et al. Chronic dialysis in patients with multiple myeloma and renal failure: a worthwhile treatment. Q J Med 1989; 73: 903–910.

4. Iggo N, Parsons V. Renal disease in multiple myeloma: current perspectives. Nephron 1990; 56: 229–233.

5. Iggo N, Winearls CG. The development of cast nephropathy in multiple myeloma. Q J Med 1998; 90: 653–656.

6. International Myeloma Working Group: Criteria for the classification of monoclonal gammopathies multiple myeloma and related disorders. A report of International Myeloma Working Group. Br J Haematol 2003; 121: 749–757.

7. Solomon A, Weiss DT, Kattine AA. Nephrotoxic potential of Bence Jones proteins. N Engl J Med 1991; 324: 1845–1851.

8. Markowitz GS. Dysproteinemia and the kidney. Adv Anat Pathol 2004; 11: 46–63.

9. Herrera GA, Joseph L, Hough A et al. Renal pathologic spectrum in an autopsy series of patients with plasma cell dyscrasia. Arch Path Lab Med 2004; 128: 875–879.

10. Korbet SM, Schwartz M. Multiple myeloma. J Am Soc Nephrol 2006; 17: 2533–2545.

11. Montseny JJ, Kleinknecht D, Meyrier A et al. Long term outcome according to renal histological lesions in 118 patients with monoclonal gammopathies. Nephrol Dial Transplant 1998; 13: 1438–1445.

12. Sanders PW, Booker BB. Pathobiology of cast nephropathy from human Bence Jones proteins. J Clin Invest 1992; 89: 630–639.

13. Ehrenfeld M. Acute renal failure precipitated by non‑steroidal anti‑inflammatory drugs in multiple myeloma. Am J Hematol 1998; 58: 142–144.

14. Pasquali S, Casanova S, Zucchelli A et al. Long term survival patients with acute and severe renal failure due to myeloma. Clin Nephrol 1990; 34: 247–254.

15. Pasquali S, Zucchelli P, Casanova S et al. Renal histological lesions and clinical syndromes in multiple myeloma. Clin Nephrol 1987; 27: 222–228.

16. Shpilberg O, Douer D, Ehrenfeld M et al. Naproxen associated fatal acute renal failure in multiple myeloma. Nephron 1990; 55: 448–449.

17. Waught DA, Ibels LS. Multiple myeloma presenting as recurrent obstructive uropathy. Aust N Z J Med 1980; 10: 555–568.

18. Border WA, Cohen AH. Renal biopsy diagnosis of clinically silent multiple myeloma. Ann Intern Med 1980; 93: 43–46.

19. Rivera F. Renal insufficiency and proteinuria: glomerulonefritis or myeloma? Nefrologia 1998; 18: 253–254.

20. Kleinknecht D. Long‑term outcome according to renal histological lesions in 118 patients with monoclonal gammopathies. Nephrol Dial Transplant 1998; 13: 1438–1445.

21. Meyrier A, Simon P, Mignon F et al. Rapidly progressive glomerulonephritis and monoclonal gammapathies. Nephron 1984; 38: 156–162.

22. Esnault VLM, Jayne DRW, Keogan MT. Anti‑neutrophil cytoplasm antibodies in patients with monoclonal gammopathies. J Clin Lab Immunol 1990; 32: 153–159.

23. Vigil A, Oliet A, Gallar P et al. Rapidly progressive immunotactoid glomerulonephritis and multiple myeloma. Nephron 1998; 79: 238–240.

24. Penfield JG. Multiple myeloma and end‑stage renal disease. Semin Dial 2006; 19: 329–334.

25. Kyle RA. Monoclonal gammopathies and the kidney. Annu Rev Med 1989; 40: 53–60.

26. Batuman V, Verroust PHJ, Navar GL. Myeloma light chains are ligand for cubilin. Am J Physiol 1998; 275: F246–F254.

27. Batuman V, Guan S. Receptor mediated endocytosis of Bence Jones proteins by proximal tubular cells. Am J Physiol 1997; 272: F521–F530.

28. Klassen RB, Allen PL, Batuman V et al. Light chains are a ligand for megalit. J Appl Physiol 2005; 98: 257–263.

29. Bradley JR, Thiru S, Evans DB. Light chains and the kidney. J Clin Pathol 1987; 40: 53–60.

30. Guillermo A, Herrera A, Sanders PW. Paraproteinemic renals disease that involve the tubulo-interstitium. Contrib Nephrol 2007; 153: 105–115.

31. Kapur U, Barton K, Fresco R et al. Expanding the pathologic spectrum of immunoglobulin light chain proximal tubulopathy. Arch Pathol Lab Med 2007; 131: 1368–1372.

32. Messiaen T, Deret S, Mougenot B et al. Adult Fanconi syndrome secondary to light chain gammopathy. Clinicopathologic heterogeneity and unusual features in 11 patients. Medicine (Baltimore) 2000; 79: 135–154.

33. Decourt C, Bridoux F, Touchard G et al. A monoclonal V kappa λ light chain responsible for incomplete proximal tubulopathy. Am J Kidney Dis 2003: 41: 497–504.

34. Ronco P, Aucouturier P, Mougenot B. Plasma cell dyscrasias-releated glomerulopathies and Fanconi’s syndrome: a molecular approach. J Nephrol 2000; 13 (Suppl 3): S34–S44.

35. Ying WZ, Sander PW. Mapping the binding domain of imunoglobulin light chain for Tammm Horsfall protein. Am J Pathol 2001; 158: 1589–1866.

36. Ying WZ, Sanders PW. Expression of Tamm Horfall glycoprotein is regulated by dietary salt in rats. Kidney Int 1998; 20: 198–210.

37. Knudsen LM, Hippe E, Hjort M et al. Renal function in newly diagnosed multiple myeloma: A demographic study of 1353 patients. The Nordic Myeloma Study Group. Eur J Haematol 1994; 53: 207–212.

38. Chanan-Khan AA, Kaufman JL, Mehta J et al. Activity and safety of bortezomib in multiple myeloma with advanced renal failure. Blood 2007; 109: 2604–2606.

39. Fakhouri F, Guerraoui H, Presne C et al. Thalidomide in patients with multiple myeloma and renal failure. Br J Haematol 2004; 125: 96–97.

40. Solling K, Solling J. Clearence of Bence Jones proteins during peritoneal dialysis of plasmapheresis in myelomatosis associated with renal failure. Contrib Nephrol 1988; 68: 259–262.

41. Zucchelli P, Pasqualli S, Cognoli L et al. Controlled plasma exchange trial in acute renal failure due to multiple myeloma. Kidney Int 1988; 33: 1175–1180.

42. Johnson WJ, Kyle RA, Pineda AA et al. Treatment of renal failure associated with multiple myeloma. Arch Intern Med 1990; 150: 863–869.

43. Clark, WF, Steward AK, Rock GA et al. Plasma exchange when myeloma presents as acute renal failure: a randomized controlled trial. Ann Intern Med 2005; 143: 777–784.

44. Gerz MA. Managing myeloma kidney. Ann Intern Med 2005; 143: 835–837.

45. Hutchison CA, Cockwell P, Reid S et al. Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma. In vitro and in vivo studies. J Amer Soc Nephrol 2007; 18: 886–895.

46. Alpers CE, Marchioro TL, Johnson RJ. Monoclonal immunoglobulin deposition disease in renal allograft recipients: probable recurrent disease in a patient with myeloma. Am J Kidney Dis 1989; 13: 418–423.

47. Röcken C, Sletten K. Amyloid in surgical pathology. Virchows Arch 2003; 443: 3–16.

48. Merlini M. WHO-IUIS nomenclature subcomittee: Nomenclature of amyloid and amyloidoses. N Engl J Med 2003; 349: 583–596.

49. Leung N, Rajkumar V. Renal manifestation of plasma cell disorders. Amer J Kidney Disease 2007; 50: 155–165.

50. Merlini M. Monoclonal gammopathy and nephropathy. Blood 2006; 108: 2520–2530.

51. Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. N Engl J Med 1997; 337: 898–909.

52. Adam Z, Ščudla V, Tomíška M. Léčba AL‑amyloidózy a ně-kte-rých dalších typů amyloidóz. Vnitř Lék 2001; 47: 46–52.

53. Adam Z, Ščudla V. Klinické projevy a diagnostika AL‑amyloidózy a ně-kte-rých dalších typů amyloidóz. Vnitř Lék 2001; 47: 36–45.

54. Kroupa R, Dastych M, Šenkyřík M et al. Systémová amyloidóza s dominující klinickou manifestací v trávicím traktu. Vnitř Lék 2005; 51: 588–592.

55. Linhartová K, Daum O. Srdeční amyloidóza. Cor Vasa 2005; 47: 328.

56. Ryšavá R. Amyloidóza ledvin. Postgrad Med 2006; 8: 207–212.

57. Ryšavá R. Léčba paraproteinemické nefropatie a primární amyloidózy ledvin. Aktual v nefrol 2005; 11: 62–65.

58. Bird JM, Fuge R, Sirohy B et al. The clinical outcome and toxicity of high‑dose chemotherapy and autologous stem cell transplantation in patients with myeloma or amyloid and severe renal impairment: a British Society of Blood and Marrow Transplantation study. Br J Haematol 2006; 134: 385–390.

59. Pirani CL, Silva F, D’Agati V et al. Renal lesions in plasma cell dyscrasias: ultrastructural observations. Am J Kidney Dis 1987; 10: 208–221.

60. Ramos R, Poveda R, Sarra J et al. Renal involvement in non malignant IgM gammopathy. Nephrol Dial Transplant 2007; 22: 627–630.

61. Randall RE, Williamson WC, Mulinax F et al. Manifestation of systemic light chain deposition. Am J Med 1976; 60: 293–299.

62. Wahner-Roedler DL, Kyle R. Heavy chain disease. Best Pract Res Clin Haematol 2005; 18: 729–746.

63. Tichý M, Maisnar V, Stulík J et al. Nemoc z těžkých řetězců µ. Klin Biochem Metab 2007; 15: 78–81.

64. Pozzi C, D’Amico M, Fogazzi GB et al. Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors. Am J Kidney Dis 2003; 42: 1154–1163.

65. Cogne M, Preudhomme JL, Bauwens M. Structure of monoclonal kappa chain of the V and IV subgroup in the kidney and plasma cells in light chain deposition disease. J Clin Invest 1991; 87: 2186–2192.

66. Gu X, Herrera AG. Light chain mediated acute tubular interstitial nephritis. Arch Pathol Lab Med 2006; 130: 165–169.

67. Gallo GR, Lazowski P, Kumar A et al. Renal and cardiac manifestations of B-cell dyscrasias with nonamyloidotic monoclonal light chain and light and heavy chain deposition disease. Adv Nephrol Necker Hosp 1998; 28: 355–382.

68. Gallo G, Picken M, Buxbaum J et al. The spectrum of monoclonal immunoglobulin deposition disease associated with immunocytic dyscrasias. Semin Hematol 1989; 26: 234–238.

69. Ganeval D, Noel LH, Preud’homme JL et al. Light chain deposition disease: Its relation with AL type amyloidosis. Kidney International 1984; 26: 1–9.

70. Ganeval D, Rabian C, Guerin V et al. Treatment of multiple myeloma with renal involvement. Adv Nephrol Necker Hosp 1992; 21: 347–370.

71. Girelli CM. Kappa light chain deposition of the liver. Eur J Gastroenterol Hepatol 1998; 10: 429–430.

72. Steuhl KP, Knorr C, Rohrbach JM et al. Paraproteinemic corneal deposits in plasma cell myeloma. Am J Ophthalmol 1991; 111: 312–318.

73. Lin J, Markowitz GS, Valeri AM et al. Renal monoclonal immunoglobulin deposition disease. The disease spectrum. J Am Soc Nephrol 2001; 12: 1482–1487.

74. Confalonieri R, Barbiano di Belgiojoso G. Light chain nephropathy: histological and clinical aspects in 15 cases. Nephrol Dial Transplant 1988; 3: 150–156.

75. Bladé J, Rosinol L. Renal, hematologic and infectious complication in multiple myeloma. Best Pract Res Clin Haematol 2005; 18: 635–652.

76. Heilman RL, Velosa JA, Holley JJ et al. Long‑term follow up and response to chemotherapy in patients with light chain deposition disease. Amer J Kidney Dis 1992; 20: 34–41.

77. Phillips AO, O’Donnel PJ, Nelson SR et al. Light chain nephropathy and anti‑neutrofil cytoplasmatic antibody associated vasculitis. Nephrol Dial Transplant 1993; 8: 1178–1180.

78. Pozzi C, D’Amico M, Fogazzi GB et al. Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors. Am J Kidney Dis 2003; 42: 1154–1163.

79. Terashima K, Takahashi K, Kojima M et al. Kappa‑type light chain crystal storage histiocytosis. Acta Pathol Jpn 1978; 28: 111–138.

80. Pock L, Stuchlík D, Herzogová J et al. Crystal storing histiocytosis of the skin associated with multiple myeloma. Int J Dermatol 2006; 45: 1408–1411.

81. Preddie CD, Markowitz GS et al. Multiple myeloma, nephrotic syndrome and crystaloid inclusions in podocytes. Kidney Int 2006; 69: 616–620.

82. Stokes MB, Aronoff B, Siegel D et al. Dysproteinemia releated nephropathy associated with crystal storing histiocytosis. Kidney International 2006; 70: 597–602.

83. Lebeau A, Zeindl-Ebergart E, Müller ECh et al. Generalized crystal storing histiocytosis with monoclonal gammopathy: molecular analysis of a disorder with rapid clinical course and review of the literature. Blood 2002; 100: 1817–1827.

84. Nasr SH, Nasr SH, Markowitz GS et al. Proliferative glomeruloneftitis with monoclonal IgG deposits: a distinct entity mimicking with immune-complex glomerulonephritis. Kidney Int 2004; 65: 85–96.

85. Rosenstock JL, Markowitz GS, Valeri AM et al. Fibrillary and immunotactoid glomerulonephritis: Distinct entities with different clinical and pathological features. Kidney Int 2003; 63: 1450–1461.

86. Soares SM, Lager DJ, Leung N et al. A proliferative flomerulonefritis secondary to a monoclonal IgA. Amer J Kidney Dis 2006; 47: 342–349.

87. Silva FG, Meyrier A, More L et al. Proliferative glomerulopathy in mutliple myeloma. J Pathol 1980; 130: 229–235.

88. Dimopoulos MA, Kyle RA, Anagnastopoulos A et al. Diagnosis and management of Wadenström’s macroglobulinemia. J Clin Oncol 2005; 23: 1564–1577.

89. Shihabi ZK. Cryoglobulins: An important but neglected clinical test. Ann Clin Lab Science 2006; 36: 395–408.

90. Ščudla V, Minařík J, Schneiderka P et al. Význam sérových hladin volných lehkých řetězců imunoglobulinu v diagnostice a hodnocení aktivity mnohočetného myelomu a vybraných monoklonálních gamapatií. Vnitř Lék 2005; 51: 1249–1259.

91. Tichý M, Hrnčíř Z, Urban P et al. Monoklonální imunoglobuliny. Klin Biochem Metabol 2004; 12: 84–87.

92. Tichý M. Monoklonální gamapatie. Labor Aktuel CS 2000; 5: 7–10.

93. Tichý M, Urban P, Matěja P et al. Laboratorní analýza souboru 3049 monoklonálních imunoglobulinů. Klin Biochem Metabol 2002; 10: 257–261.

94. Tichý M. Viscosity of paraproteinemic séra. Acta Med 1996; 39: 41–43.

95. Tichý M. Laboratorní analýza monoklonálních imunoglobulinů (paraproteinů). Český Těšín: Finidr 1997.

96. Špička I, Mašek Z, Jirsa M et al. Interleukin‑6, tumor-nekrotizující faktor a jejich solubilní receptory u Bence-Jonesovy nefropatie – možná úloha v patogenezi a význam stanovení pro prognózu renální insuficience. Klin Onkol 1996; 9: 126–129.

97. Špička I, Merta M, Cieslar P et al. Postižení ledvin u monoklonálních gamapatií. Čas Lék Čes 1996; 135: 374–377.

98. Špička I, Merta M, Cieslar P et al. Postižení ledvin u monoklonálních gamapatií. Klinická studie. Čas Lék Čes 1995; 134: 478–481.

99. Ščudla V, Nekula J, Bačovský J et al. Nukleární magnetická rezonance v hodnocení páteře u mnohočetného myelomu. Čes Revmatol 1997; 5: 51–52.

Labels
Diabetology Endocrinology Internal medicine
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#