Myeloma nephropathy as one of the most difficult diseases from the point of view of diagnosis and treatment

Diagnosis is made by urine testing (sulfosalicylic acid test or protein electrophoresis) or by kidney biopsy. Treatment is aimed at treating multiple myeloma and ensuring adequate urine flow.

Tubulointerstitial and glomerular lesions are most characteristic of kidney damage in myeloma. The direct mechanisms of light chain damage to nephrons are unknown.

Tubulointerstitial disease. The light chains are reabsorbed in the proximal tubule, reach the distal nephron and bind to filtered proteins and Tamm-Horsfall mucoprotein (secreted by cells of the thick ascending tubule of Henle) to form an obstructive deposit. The term myeloma kidney or myeloma tubular nephropathy usually refers to the tubulointerstitial disorders that occur as a result of these processes. The following factors predispose to the formation of sediment:

• low rate of urine flow,
• X-ray contrast agents,
• hyperuricemia,
• NSAIDs,
• increased NaCL concentration in the tubular lumen (for example, under the influence of loop diuretics),
• increased levels of intracanalicular calcium due to hypercalcemia, which often develops secondary to bone breakdown in multiple myeloma.

Other types of tubulointerstitial disorders associated with Bene Jones proteinuria include proximal tubular transport disorders causing Fanconi syndrome and interstitial light chain deposition with inflammatory infiltrates and active tubular damage.

Glomerulopathies . Myeloma glomerulopathy is characterized by 2 mechanisms: primary (AL) amyloidosis and glomerular deposition of light chains or, rarely, heavy chains. AL amyloidosis manifests itself as glomerular accumulation of AL amyloid in the mesangium, subepithelial or subendothelial, or combined. Amyloid deposition occurs in chaotic, non-branching fibers consisting of various sections of light chains. Light chain disease (LCD), which can be associated with lymphoma and Waldenström's macroglobulinemia, is the deposition of unpolymerized light chains (i.e., without fibers) in glomeruli, usually permanent portions of the chains.

Myeloma nephropathy clinic symptoms treatment – ​​Our health

Myeloma nephropathy is a fatal disease characterized by kidney damage.
The tissues of the organ become denser, acquire a bright red tint, and the kidneys increase in size. The consequence of the disease is progressive renal failure, which is impossible to get rid of. In addition, the disease is accompanied by vascular atherosclerosis. With timely treatment, it is possible to prolong the period of remission and the patient’s quality of life.

Elderly people are at risk. Nephropathy in this case is a manifestation of myeloma, a malignant oncological disease, which is characterized by the appearance of multiple tumor growths throughout the body.

Etiology

The disease is characterized by damage to the renal tubules and glomeruli caused by myeloma . The latter is a cancerous disease, the essence of which is the production of a large number of plasma cells by the bone marrow.

Thus, the main cause of nephropathy is myeloma . Cancer cells release pathological Bence Jones protein into the blood, which is deposited on the surface of the kidneys and provokes scarring of the organ tissue.

In the early stages of the disease, provided that the patient’s kidneys are healthy, protein molecules penetrate the openings of the kidney membranes. Here they oxidize and coagulate. The toxins that appear during this block the function of the kidney glomeruli.

As a result, the pressure in the latter increases, and its performance deteriorates. Over time, due to high intrarenal pressure, the tissues of the organ are replaced by connective tissue, resulting in kidney dysfunction.

In addition, under the influence of oxidized protein, nephrosis (that is, damage to the kidney) occurs because its filtration is impossible due to blocked renal tubules.

Clinical picture

The disease is characterized by the complexity of diagnosis, which is associated with the absence of specific and obvious signs of myeloma nephropathy. With the disease, functional renal failure progresses (it causes death in 30%), which, however, has almost no symptoms.

An indicative symptom is proteinuria, that is, the presence of protein in the urine. This may be one of its forms: mini- or macroproteinuria. The latter is more common - the level of protein in the urine can reach 50-60 g/l .

Sometimes proteinuria is detected even without a clinical urine test - by the foam cap in the urine. However, this sign does not always mean proteinuria. In addition, there are small traces of blood in the urine. We are talking about microhematuria.

The clinical picture is complemented by symptoms characteristic of multiple myeloma:

• Bone pain.
• Osteoporosis.
• Increased bone fragility, frequent fractures.
• Hypercalcemia (that is, an increase in the amount of calcium in the blood)
• Deformation of the bones, leading to changes in the skeleton and a decrease in the patient’s height.
• Frequent infectious diseases of bacterial etiology,
• Anemia.

In rare cases, the patient suffers from swelling. His blood pressure tends to drop as the cancer progresses.

Diagnostic methods

The first method of diagnosis is to test urine for protein content. If the result is positive, the task of further research is to differentiate the disease in question and glomerulonephritis .

Indicative should be the patient’s absence in the past of staphylococcal and streptococcal infections and exacerbations of glomerulonephritis. In this case, the doctor may suspect nephropathy, etiologically related to myeloma.

“Unreasonable” proteinuria, an increase in the number of leukocytes in the blood and unexplained anemia, especially in people over 35-40 years of age, should be a reason to think about the presence of myeloma nephropathy in the patient.

To establish a diagnosis, 3 types of diagnostics must be carried out:

• Urine electrophoresis (detects Bence Jones protein in urine)
• Determination of paraproteins in blood and urine.
• Sternal puncture, through which the level of plasma cells is determined.

Renal puncture biopsy is used extremely rarely. Primarily due to the lack of information content. Despite the fact that a biopsy can exclude glomerulonephritis and amyloidosis, morphological changes in the organ can be diverse.

This, in turn, does not give reason to talk exclusively about the development of nephropathy against the background of myeloma. Secondly, this diagnostic method is difficult to perform and there is a risk of patient death.

Treatment

Today, myeloma nephropathy is considered an incurable disease. The goal of treatment measures is to improve the quality and increase the patient's life expectancy . With timely treatment, it is possible to increase the patient’s life expectancy by 5, less often 7-10 years.

In order to achieve a period of remission, cytostatics (cyclophosphamide, sarcolysin) and glucocorticosteroids are prescribed. In combination with anabolic hormones they give stable and long-term (up to 2-4 years) remission.

However, they are contraindicated in renal failure. Then they resort to symptomatic therapy. Peritoneal dialysis (blood purification, in which the peritoneum takes over the function of the filtering organ), hemodialysis (another method of extrarenal blood purification), and kidney transplantation are not recommended.

Forecast

The disease has a poor prognosis . Treatment depends on the severity of the lesion, the effectiveness of cytostatic therapy, and the rate of progression of renal failure. During treatment, it is possible to increase the patient’s life expectancy to 5-10 years and achieve stable remission.

Moreover, in 60% of cases, acute leukemia . The main causes of death are death from infection and acute renal failure.

Prevention

The only preventive measures can be called regular preventive medical examinations and contacting specialists at the first signs of the disease.

Achieving long-term remission will be achieved by following the doctor’s instructions.

Source: https://zdorovjana.ru/mielomnaja-nefropatija-klinika-simptomy-lechenie.html

Forecast

The disease has a poor prognosis

. Treatment depends on the severity of the lesion, the effectiveness of cytostatic therapy, and the rate of progression of renal failure. During treatment, it is possible to increase the patient’s life expectancy to 5-10 years and achieve stable remission.

Moreover, in 60% of cases, acute leukemia

. The main causes of death are death from infection and acute renal failure.

Myeloma nephropathy: causes, diagnosis and treatment

Myeloma nephropathy is a fatal disease characterized by kidney damage. The tissues of the organ become denser, acquire a bright red tint, and the kidneys increase in size.

The consequence of the disease is progressive renal failure, which is impossible to get rid of. In addition, the disease is accompanied by vascular atherosclerosis. With timely treatment, it is possible to prolong the period of remission and the patient’s quality of life.

Elderly people are at risk. Nephropathy in this case is a manifestation of myeloma, a malignant oncological disease, which is characterized by the appearance of multiple tumor growths throughout the body.

Prevention

The only preventive measures can be called regular preventive medical examinations and contacting specialists at the first signs of the disease.

Achieving long-term remission will be achieved by following the doctor’s instructions.

Myeloma nephropathy is a kidney disease in which organs become hardened, enlarged, and bright red in color. In exceptional cases, they shrink and become wrinkled. The disease occurs mainly in elderly people. Therefore, its frequent companion is vascular atherosclerosis, as well as renal ischemia.

Myeloma nephropathy

Myeloma nephropathy (with multiple myeloma): symptoms and treatment – ​​Medicine

Myeloma nephropathy is a fatal disease characterized by kidney damage. The tissues of the organ become denser, acquire a bright red tint, and the kidneys increase in size.

The consequence of the disease is progressive renal failure, which is impossible to get rid of. In addition, the disease is accompanied by vascular atherosclerosis. With timely treatment, it is possible to prolong the period of remission and the patient’s quality of life.

Elderly people are at risk. Nephropathy in this case is a manifestation of myeloma, a malignant oncological disease, which is characterized by the appearance of multiple tumor growths throughout the body.

Other diseases from the group Diseases of the genitourinary system:

Myeloma nephropathy: ICD-10 code, pathogenesis, symptoms, treatment

Kidney diseases provoked by other pathologies require treatment of the root cause of the disease, as a result of which the nephrological pathology is cured or goes into remission on its own. But if the cause of the disease is incurable, a special approach is required to the patient. This can be seen in the example of myeloma nephropathy.

• 1 Myeloma nephropathy
• 2 Pathogenesis
• 3 Symptoms
• 4 Diagnostics
• 5 Treatment

Myeloma nephropathy

Myeloma nephropathy is a lesion of the glomeruli and tubules of the kidney due to myeloma. Multiple myeloma is a malignant oncology in which the human bone marrow produces a large number of plasma cells.

The pathological protein released into the bloodstream by myeloma cells is deposited in the kidney tissue, leading to a phenomenon called nephropathy - tissue scarring. Today this disease is incurable. In addition, it is difficult to diagnose.

The disease code according to ICD-10 is C90.

Pathogenesis

Plasma cells circulating in the bloodstream in myeloma produce Bence-Jones Protein.

The size of the protein molecule allows it to pass through holes in the kidney membranes even if they are intact, that is, with absolutely healthy and undamaged glomerular tissue.

But if the protein is oxidized inside the kidney, the process of coagulation occurs, and the resulting substance blocks the work of the glomeruli.

Blood pressure inside the kidney increases, the filtration capacity of the organ is impaired. High intrarenal pressure leads to tissue damage; the affected areas are scarred by replacement tissue, which cannot perform a functional load.

In addition, impaired filtration due to blocked renal channels leads to nephroptosis, which also provokes kidney damage.

Myeloma nephropathy occurs at varying rates, but the prognosis is always unfavorable. With the help of early diagnosis, which statistically occurs extremely rarely, doctors can achieve remission of the patient, lasting up to 5 years (in exceptional cases - up to 10 years).

Pathogenesis of myeloma nephropathy

Symptoms

A distinctive feature of myeloma nephropathy is the nonspecificity of symptoms. Comparing the pathology with glomerulonephritis, in which damage to kidney tissue is also recorded, one can see that in the first case the patient is faced with the classic picture of chronic nephrogenic insufficiency: the formation of pastosity and edema and an increase in blood pressure.

In myeloma nephropathy, functional renal failure progresses at a rapid rate, but without any symptoms indicating this process. This negatively affects the diagnostic process and deprives the patient of the opportunity to begin treatment in a timely manner.

The only specific symptom that is always present in the clinical picture of the disease against the background of multiple myeloma is proteinuria, in other words, the presence of protein in urine. At the same time, it is more relevant to talk about macroproteinuria, since the amount of protein in the urine can reach 50-60 grams per liter.

Sometimes proteinuria can be noticed even without a urine test - by the foam that forms when urinating. But this sign cannot be characterized as specific, in addition, this fact is easy to overlook.

Considering the fact that myeloma affects not only the kidneys, but also the human skeletal system, the list of symptoms includes bone pain.

Clinical picture of myeloma nephropathy

Diagnostics

Diagnosis of nephropathy in myeloma usually begins with urine analysis and detection of proteinuria. It is important to differentiate the pathology from glomerulonephritis. If the patient has not previously had staphylococcal and streptococcal infections, as well as an acute form of glomerulonephritis, there is reason to suspect myeloma nephropathy and continue the diagnosis.

An accurate diagnosis is made after three studies:

• urine electrophoresis, which determines the composition of urine and detects not albumin, but Bence-Jones protein;
• detection of paraproteins in blood and urine;
• performing a sternal puncture to determine the number of plasma cells.

Sternal puncture is the most relevant method. Diagnosis of myeloma against the background of progressive renal failure and high proteinuria makes it possible to make a diagnosis with maximum accuracy.

Nephrobiopsy is included in the diagnostic plan for suspected myeloma nephropathy extremely rarely, since taking tissue from an organ for microscopic examination is a rather complex and dangerous process from a technical point of view. Sternal puncture, coupled with urine and blood tests, allows us to make the diagnosis as accurately as possible.

Myeloma nephropathy: treatment, prognosis, symptoms – Smart Doctor

Kidney diseases provoked by other pathologies require treatment of the root cause of the disease, as a result of which the nephrological pathology is cured or goes into remission on its own. But if the cause of the disease is incurable, a special approach is required to the patient. This can be seen in the example of myeloma nephropathy.

• 1 Myeloma nephropathy
• 2 Pathogenesis
• 3 Symptoms
• 4 Diagnostics
• 5 Treatment

What is nephropathy?

Myeloma nephropathy is a kidney disease characterized by hardening of the organ, subsequent enlargement and acquisition of a bright red hue. This occurs due to damage to the renal nephrons by pathological proteins. Proteins accumulate in the distal parts of the kidney, which gradually clogs and damages the tubules. As a result, the kidney shrinks and decreases in size.

The risk group for developing myeloma nephropathy includes older people. The danger of the disease is represented by the development of organ ischemia and vascular atherosclerosis.

With multiple myeloma, pathological tumor foci form throughout the body, including in the kidney tissues

Symptoms of the disease

Kidney diseases often manifest as pain in the lumbar region and swelling of the extremities. But the symptoms of myeloma nephropathy are significantly different. There are no pronounced symptoms, so it can only be detected through regular examination.

Proteinuria

Proteinuria is the main symptom of the development of renal nephropathy. Symptoms include the detection of protein in the urine, and this can occur over many years. Proteinuria is found in 65% of patients with myeloma nephropathy. Protein levels can reach 66 g/l with a maximum allowable value of 0.14 g/l.

Kidney diseases with the characteristic presence of Bence Jones protein in the urine indicate the rapid development of renal failure. In the case of myeloma nephropathy, this criterion is also the main one, although it is not identified immediately in all cases. During standard heating of urine to 50-60 degrees Celsius, protein determination occurs only in 30-40% of cases.

The presence of Bence Jones protein in the urine makes it possible to highly likely assume that the patient has multiple myeloma.