title: The pathogenesis and diagnosis of acute kidney injury in multiple myeloma.
abstract: 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.
authors: Renal Institute of Birmingham, University Hospital Birmingham and University of Birmingham, Birmingham, UK. c.a.hutchison@bham.ac.uk
authors: Colin A
authors: CA
authors: Hutchison
authors: Vecihi
authors: V
authors: Batuman
authors: Judith
authors: J
authors: Behrens
authors: Frank
authors: F
authors: Bridoux
authors: Christophe
authors: C
authors: Sirac
authors: Angela
authors: A
authors: Dispenzieri
authors: Guillermo A
authors: GA
authors: Herrera
authors: Helen
authors: H
authors: Lachmann
authors: Paul W
authors: PW
authors: Sanders
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology* / Q000628:therapy