PMID- 8184190
OWN - NLM
STAT- MEDLINE
DCOM- 19940616
LR  - 20061115
IS  - 0034-1193 (Print)
IS  - 0034-1193 (Linking)
VI  - 85
IP  - 2
DP  - 1994 Feb
TI  - [The kidney in multiple myeloma. The physiopathological and clinical aspects].
PG  - 123-33
AB  - The renal concern in a multiple myeloma (MM) case has a frequency of 50% and 
      causes a worsening of the disease with a survival average of about 12 months. The 
      monoclonal light free chains (CLL) produced in excess by the plasmacytes are 
      present in the urine as proteinuria of Bence Jones (PBJ) in 60-70% of patients 
      affected by MM. They represent the major pathogenetic factor of the nephropathy 
      in course of MM as they can deposit in shape of intratubular "casts" in the 
      myeloma casts nephropathy (MCN). In some worse cases, dehydration or 
      hypercalcaemia can cause an irreversible acute renal insufficiency (RI). It is 
      therefore important in a patient affected with MM with PBJ to prevent, locate and 
      opportunely treat these situations which worsen the nephropathy. Beside the 
      tubular cast nephropathy, the CLL "accumulate" in the kidney even though with a 
      lower frequency compared to MCN, in the light chains deposition disease (LCDD) 
      and in the amyloidosis AL (AL). LCDD is characterized by a deposit of nodular 
      amorphous materials PAS positive in the glomerulus and sometimes even in the 
      tubulus. It usually presents itself as a chronic RI and a proteinuria causing 
      nephrotic syndrome (NS). This quickly evolves into uraemia and its evolution can 
      be lessened by the MM treatment. AL in course of MM also reveals with a chronic 
      RI and NS. CLLs deposit in the typical fibrillar structure, on the vessel walls, 
      in the glomerulus, in the mesangium and can be marked out with the Congo red 
      colouring and the subsequent green birefringence through microscope with 
      polarized light. Prognosis of AL is extremely severe and no benefit is given by 
      the treatment of the hematological illness. It is therefore absolutely necessary 
      to study the renal histology through biopsy when MM is grade B, that is, with 
      serumal creatinine above 2 mg/dl as: MCN imposes the MM treatment programme in 
      order to reduce the tubular excess of PBJ and to attempt to make RI reversible; 
      MCN with tubular atrophy and interstitial fibrosis results in an unfavourable 
      prognosis as it expresses a nephropathic irreversibility due to the loss 
      nephrons. It will therefore necessary to start on a renal substitutional 
      treatment programme. Renal damage in course of MM is not always tubular, rather 
      an unexpected glomerular damage of LCDD or amyloidosis AL type can be 
      found.(ABSTRACT TRUNCATED AT 400 WORDS)
FAU - Vivaldi, P
AU  - Vivaldi P
AD  - UO Medicina 2o, Istituto Ospedaliero S. Chiara, Trento.
FAU - Comotti, C
AU  - Comotti C
FAU - Pedrazzoli, M
AU  - Pedrazzoli M
LA  - ita
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Il rene nel mieloma multiplo. Aspetti fisio-patologici e clinici.
PL  - Italy
TA  - Recenti Prog Med
JT  - Recenti progressi in medicina
JID - 0401271
RN  - 0 (Immunoglobulin Light Chains)
SB  - IM
MH  - Amyloidosis/immunology/physiopathology
MH  - Humans
MH  - Hypergammaglobulinemia/immunology/physiopathology
MH  - Immunoglobulin Light Chains
MH  - Kidney/immunology/*physiopathology
MH  - Kidney Diseases/immunology/physiopathology
MH  - Multiple Myeloma/diagnosis/*physiopathology
RF  - 47
EDAT- 1994/02/01 00:00
MHDA- 1994/02/01 00:01
CRDT- 1994/02/01 00:00
PHST- 1994/02/01 00:00 [pubmed]
PHST- 1994/02/01 00:01 [medline]
PHST- 1994/02/01 00:00 [entrez]
PST - ppublish
SO  - Recenti Prog Med. 1994 Feb;85(2):123-33.