TY - JOUR
T1 - The pathogenesis and diagnosis of acute kidney injury in multiple myeloma
AU - Hutchison, Colin A.
AU - Batuman, Vecihi
AU - Behrens, Judith
AU - Bridoux, Frank
AU - Sirac, Christophe
AU - Dispenzieri, Angela
AU - Herrera, Guillermo A.
AU - Lachmann, Helen
AU - Sanders, Paul W.
N1 - Funding Information:
The authors of this manuscript would like to thank the other members of the International Kidney and Monoclonal Gammopathy Research Group for their intellectual support in the review process for this manuscript: J. Bladé, P. Cockwell, M. Cook, M. Drayson, J.-P. Fermand, S. Kastritis, R. Kyle, N. Leung and C. Winearls. P. W. Sanders’ research was supported by National Institutes of Health grant R01 DK46199 and P30 DK079337 (George M. O’Brien Kidney and Urological Research Centers Program) and the Office of Research and Development, Medical Research Service, Department of Veterans Affairs.
PY - 2012/1
Y1 - 2012/1
N2 - Renal failure remains a principal cause of morbidity for patients with multiple myeloma. Once reversible factors such as hypercalcemia have been corrected, the most common cause of severe renal failure in these patients is a tubulointerstitial pathology that results from the very high circulating concentrations of monoclonal immunoglobulin free light chains. These endogenous proteins can result in isolated proximal tubule cell cytotoxicity, tubulointerstitial nephritis and cast nephropathy (myeloma kidney). Less frequently, high levels of free light chains can lead to immunoglobulin light chain amyloidosis and light chain deposition disease, although these conditions are usually associated with insidious progression of renal failure rather than acute kidney injury. Unless there is rapid intervention, progressive and irreversible damage occurs, particularly interstitial fibrosis and tubular atrophy. Despite advances in our understanding of the pathogenesis of these processes there has been a gap in translating these achievements into improved patient outcomes. The International Kidney and Monoclonal Gammopathy Research Group was formed to address this need. In this Review, we discuss the mechanisms of disease and diagnostic approaches to patients with acute kidney injury complicating multiple myeloma.
AB - Renal failure remains a principal cause of morbidity for patients with multiple myeloma. Once reversible factors such as hypercalcemia have been corrected, the most common cause of severe renal failure in these patients is a tubulointerstitial pathology that results from the very high circulating concentrations of monoclonal immunoglobulin free light chains. These endogenous proteins can result in isolated proximal tubule cell cytotoxicity, tubulointerstitial nephritis and cast nephropathy (myeloma kidney). Less frequently, high levels of free light chains can lead to immunoglobulin light chain amyloidosis and light chain deposition disease, although these conditions are usually associated with insidious progression of renal failure rather than acute kidney injury. Unless there is rapid intervention, progressive and irreversible damage occurs, particularly interstitial fibrosis and tubular atrophy. Despite advances in our understanding of the pathogenesis of these processes there has been a gap in translating these achievements into improved patient outcomes. The International Kidney and Monoclonal Gammopathy Research Group was formed to address this need. In this Review, we discuss the mechanisms of disease and diagnostic approaches to patients with acute kidney injury complicating multiple myeloma.
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U2 - 10.1038/nrneph.2011.168
DO - 10.1038/nrneph.2011.168
M3 - Review article
C2 - 22045243
AN - SCOPUS:84455205655
SN - 1759-5061
VL - 8
SP - 43
EP - 51
JO - Nature Reviews Nephrology
JF - Nature Reviews Nephrology
IS - 1
ER -