11- MULTIPLE MYELOMA

• Kidney disease


  • One of the most common complications in multiple myeloma
• Multiple myeloma


  Occurs in elderly, must be above 40 years old
• Triad of symptoms in multiple myeloma

  • Anemia
  • Hypercalcemia (because of bone resorption in osteolytic lesions)
  • Renal failure
• Kidneys in multiple myeloma


  • Normal sized, Nodular sclerosis (Kimmelstiel–Wilson) like diabetes
• To diagnose multiple myeloma, request serum free light chain (typically it is kappa ҡ)
• Diagnosis of multiple myeloma


  • Bone marrow: =/> 10% plasma cells
  • Albumin/protein ratio < 0.5 (should normally be >0.5), because of the Igs added to the proteins
  • S-protein & urine electrophoresis shows the monoclonal gamma spike, but are not done anymore
  • Urine protein is trace but 24hr protein shows significant proteinuria because dipstick only detect albumin (not Igs)
  • Nodular light chain casts seen in renal biopsy (Ig deposits within renal tubules) & positive immunofluorescence
• Multiple myeloma and amyloidosis are referred to specialist centers and treated by the same oncologist