Multiple Myeloma and Kidney Failure: What is the link?| Dr Gaurav Dixit

Posted by Dr Gaurav Dixit on August 20th, 2019

      Multiple Myeloma and Kidney Failure: What is the link?

Have you ever come across the term ‘Myeloma kidney’? This indicates that the patients who are affected by multiple myeloma are prone to a complication of some amount of kidney failure. It has been estimated that around 20 to 40 % of patients with multiple myeloma are easily vulnerable to kidney failure. As multiple myeloma itself is a serious condition, its symptoms and complications are too fatal. So immediate medical attention has to be sought by affected patients. This blog sheds some light on the link between the myeloma and kidney failure, their diagnosis and treatment.

What is multiple myeloma?

• Human blood has plasma cells which are specialized immune cells that make antibodies to fight off any infection. 

• Multiple myelomas are a type of blood cancer that affects these plasma cells. 

• The plasma cells become abnormal and they fail to produce normal antibodies. Instead, they produce too much protein that gets accumulated in the blood. 

• This condition can aggravate several other complications such as bone disease, anaemia, renal disease, risk of infection and increased levels of calcium.

How does Multiple Myeloma affect kidneys?

The most common complication of multiple myeloma is kidney failure. Kidneys have tubules at their ends where the blood gets filtered and exit the kidney in the form of liquid waste called urine. They are also made up of glomeruli, which acts as small filters. 

• When you have multiple myeloma, the abnormal proteins produced by plasma cells come in contact with glomeruli and tubules

• When they enter into tubules, they interact with some other proteins to form long chains of complicated protein molecules. 

• These combinations of proteins might block the tubules and the urine cannot pass out freely.

• Thus the blockages lead to loss of kidney function and hence kidney failure occurs.

• In addition, an inflammatory reaction occurs in kidney tissues as these proteins interact with renal tissues.

• Thus the overall combination of blockages and inflammation result in myeloma kidney.

How this is diagnosed?

Myeloma kidney is most commonly diagnosed by a biopsy. Additionally, some other tests are done which include blood tests, urine tests, x-rays of the bones, and a bone marrow biopsy. 

• The blood tests and urine tests can figure out the presence of abnormal proteins

• The x-rays of the bones can detect some lesions in the bones

• The biopsy of bone marrow will detect the presence of abnormal plasma cells inside the bones

How it is treated?

The extent of damage to the kidney can be greatly reduced and prevented if detected in early stages. There are treatment options available to reverse the kidney damage caused by this cancer. The treatment methods for multiple myeloma is equally effective in treating myeloma kidney as well.

• Chemotherapy greatly helps out in minimizing the amount of production of abnormal proteins by plasma cells. Thus the kidneys can very well recover if this protein content is largely reduced.

• It is important to stay hydrated to recover from kidney damage. Dehydration may lead to excess protein formation.

• It is better to avoid NSAIDs and Diuretics as they trigger more proteins to block the tubules.

• To control high calcium levels in the blood, pamidronate and zoledronic acid medications are recommended.

When appropriate treatment is obtained at an early stage, the long term outlook of a patient can be significantly improved.