Myeloma kidney is a tubulointerstitial pathology that accounts for approximately 80–90% of severe acute kidney injury in patients with multiple myeloma. Unless there is rapid intervention, progressive irreversible damage from interstitial fibrosis and tubular atrophy occurs. Work over the past decade has demonstrated that an early sustained reduction in serum concentrations of pathogenic monoclonal free light chains (FLCs) leads to improved renal recovery rates. In turn, an early improvement in renal function is associated with improved patient survival. An early reduction in FLC levels should therefore become standard of care, although the optimum mechanisms to achieve this depletion of FLCs remain to be determined. To provide a coordinated, cross-disciplinary approach to research in this disease, the International Kidney and Monoclonal Gammopathy Research Group was formed. In this Review, we address the current state of knowledge in the management of myeloma kidney.
Recovery of renal function in patients with myeloma kidney requires an early substantial reduction in serum free light chain concentrations
Immediate treatment with high-dose dexamethasone is essential in patients with myeloma kidney
The proteasome inhibitor bortezomib provides rapid and high rates of myeloma response without the need for dose modification in patients with renal failure
The immunomodulatory drugs thalidomide and lenalidomide are both associated with improved outcomes in patients with kidney disease associated with myeloma
A role for free light chain removal by high cut-off hemodialysis in patients with myeloma kidney remains to be proved
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C. A. Hutchison has received speakers bureau honoraria and grant/research support from Binding Site. M. Cook has received speakers bureau honoraria from Celgene and Janssen. The other authors declare no competing interests.
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Hutchison, C., Bladé, J., Cockwell, P. et al. Novel approaches for reducing free light chains in patients with myeloma kidney. Nat Rev Nephrol 8, 234–243 (2012). https://doi.org/10.1038/nrneph.2012.14
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