title: Pathogenesis of renal failure in multiple myeloma: any role of contrast media?
abstract: The spectrum of kidney disease-associated monoclonal immunoglobulin and plasma cell malignancies is remarkably broad and encompasses nearly all nephropathologic entities. Multiple myeloma with kidney impairment at presentation is a medical emergency since the recovery of kidney function is associated with survival benefits. In most cases, kidney impairment may be the first clinical manifestation of malignant plasma cell dyscrasias like multiple myeloma and light chain amyloidosis. Multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media. The risk is increased by comorbidities such as chronic kidney disease, diabetes, hypercalcemia, dehydration, and use of nephrotoxic drugs. Before the administration of contrast media, the current recommended laboratory tests for assessing kidney function are serum creatinine measurement and the estimation of glomerular filtration rate by using the CKD-EPI equation. The assessment of Bence Jones proteinuria is unnecessary for evaluating the risk of kidney failure in patients with multiple myeloma, since this test cannot be considered a surrogate biomarker of kidney function.
authors.affiliation: Laboratory Medicine Service, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University-Hospital San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Mussap
authors.affiliation: Amyloidosis Research and Treatment Center, Clinical Chemistry Laboratories, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy ; Department of Molecular Medicine, University of Pavia, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000686:Amyloidosis / Q000652:urine; D000818:Animals; D001536:Bence Jones Protein / Q000652:urine; D003287:Contrast Media / Q000009:adverse effects* / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000652:urine; D009101:Multiple Myeloma / Q000469:parasitology*; D011507:Proteinuria / Q000139:chemically induced / Q000503:physiopathology / Q000652:urine; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000503:physiopathology* / Q000652:urine*
chemical_list: D003287:Contrast Media; D007147:Immunoglobulin Light Chains; D001536:Bence Jones Protein