MULTIPLE MYELOMA NEPHROPATHY

SUMMARY

1. Cast nephropathy (myeloma kidney) - Bence Jones proteins precipitate in the tubules leading to ARF. Myeloma cast nephropathy is negative dipstick protein but positive proteinuria on lab measurement because the dipstick reacts to albumin but not the light chains.

2. Hypercalcemia - can cause renal failure.

3. Primary "AL" amyloidosis - multisystem disease that can include nephrotic syndrome & RF. Congo-red stain shows deposits with apple-green birefringence.

4. Monoclonal Ig deposit disease (MIDD) - monoclonal immunoglobulin light chains/heavy chains are deposited in the GBM. Pathologically MIDD can resemble diabetic nephropathy, with nodular glomerulosclerosis.

5. Secondary "AA" amyloidosis - seen in chronic inflammatory states (RA), can also be caused by recurrent skin and soft tissue infections such as those caused by chronic injection drug use.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].