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      Multiple Myeloma in Chronic Kidney Disease

      a , b , a

      Nephron Clinical Practice

      S. Karger AG

      Myeloma, Serum electrophoresis, Chronic kidney disease

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          Abstract

          Introduction: The incidence of multiple myeloma (MM) has increased in Scotland over the last 20 years. Approximately 25% of cases present directly to renal services. Serum electrophoresis is commonly included in the diagnostic screening tests performed in patients with chronic kidney disease (CKD). We examined the utility of serum electrophoresis in the population presenting to renal outpatient services in Glasgow. Methods: All new patient attendances at general nephrology clinics in the Glasgow renal units between 1/08/2004 and 31/07/2006, along with clinical data, were retrieved from the electronic patient records. Patients with acute kidney injury were excluded. All serum and urine electrophoresis requests and results for the same period were identified from Biochemistry and Immunology Laboratory Services. Results: A total of 2,544 new patients attended a renal clinic for the first time in the inception period, of whom 1,608 (63.2%) had serum electrophoresis tested. One patient with MM was identified, but the diagnosis was clinically apparent before the serum electrophoresis result was requested. A further 40 subjects had abnormal serum electrophoresis with mean paraprotein of 8.3 g/l (SD 6.1); none of these patients have subsequently developed MM, and the renal abnormalities are felt to be unrelated. This prevalence of monoclonal gammopathy of uncertain significance in 2.5% of the cohort is consistent with the expected prevalence in the general population. Conclusion: Our data demonstrate that serum electrophoresis in patients with CKD is not a useful screening test to identify MM.

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          Most cited references 12

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          Renal failure in multiple myeloma. Pathogenesis and prognostic implications.

          The pathogenesis, prognosis, and reversibility of renal failure were assessed in 494 consecutive, previously untreated patients with multiple myeloma. For patients with a similar extent of disease, the presence or degree of azotemia did not adversely affect prognosis. Hypercalcemia and/or Bence Jones proteinuria explained the renal failure in 97% of patients. After treatment with a combination of hydration and chemotherapy, normal renal function was achieved in 51% of patients, reversibility usually being rapid and occurring more often in those with slight elevation of serum creatinine. Myeloma control was much more important for survival prolongation than reversal of renal failure, supporting the prompt institution of effective therapy for the underlying malignancy.
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            Anemia in the elderly: current understanding and emerging concepts.

            Anemia is currently defined by the World Health Organization (WHO) as a hemoglobin (Hb) level <13 g/dL in men and <12 g/dL in women. While estimates vary widely, nearly one quarter of community-based octagenerians and one half of the chronically ill elderly have Hb levels that satisfy a diagnosis of anemia according to these criteria. A growing body of evidence has linked adverse events with even "mild" anemia or low-normal Hb in the elderly. Recent studies suggest strongly that aging is associated with dysregulation of pro-inflammatory cytokines, most notably interleukin-6 (IL-6), which may negatively impact hematopoiesis, either by inhibition of erythropoietin (EPO) production or interaction with EPO receptors. Anemia in older individuals is associated with a very wide range of complications, including increased risk for mortality, cardiovascular disease, cognitive dysfunction, longer hospitalization for elective procedures and comorbid conditions, reduced bone density, and falls and fractures. Not surprisingly, anemia also has a significant effect on quality of life (QOL) in the elderly. Most anemia in older individuals results from iron deficiency, chronic inflammation, or chronic kidney disease, or it may be unexplained. Future research on anemia in the elderly should focus on the age-related physiologic changes underlying this condition and whether anemia correction can reduce anemia-associated risks, and improve QOL.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2009
                January 2009
                22 November 2008
                : 111
                : 1
                : c7-c11
                Affiliations
                aRenal Unit and bHaematology, Western Infirmary, Glasgow, UK
                Article
                175798 Nephron Clin Pract 2009;111:c7
                10.1159/000175798
                19033691
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 2, References: 21, Pages: 1
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                Serum electrophoresis, Myeloma, Chronic kidney disease

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