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Nephrol Dial Transplant (2003) 18: 1431-1434
© 2003 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

The radical treatment of paraprotein disorders affecting the kidney

Andrew J. Peniket1, Timothy J. Littlewood1 and Christopher G. Winearls2

1 Department of Haematology, John Radcliffe Hospital and 2 Oxford Kidney Unit, The Churchill Hospital, The Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

Correspondence and offprint requests to: Dr A. J. Peniket, Department of Haematology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. Email: andy.peniket@orh.nhs.uk

Keywords: amyloidosis; bone marrow transplantation; myeloma; renal failure

The first 150 words of the full text of this article appear below.

When a paraprotein causes renal injury, cyotoxic treatment may be directed against the underlying plasma cell clone, in the hope of reversing, halting or minimizing the damage. Bolder, high-dose cytotoxic regimens are now being used for these disorders and are the subject of this review.

Multiple myeloma

Multiple myeloma is the classic disorder in which paraproteinaemia causes renal dysfunction. It is a malignant disease of plasma cells characterized by bone pain, anaemia, immunosuppression and renal impairment. Renal failure is present at the time of diagnosis in 20–30% of patients with myeloma, and is due mainly to the nephrotoxic effects of the abnormal immunoglobulin light chains [1], but may be exacerbated by hypercalcaemia, dehydration and drugs [2].

Conventional cytotoxic treatment for myeloma includes melphalan (with or without prednisolone) [3] or combination chemotherapy using regimens such as VAD (vincristine, adriamycin and dexamethasone) [4]. Randomized trials show . . . [Full Text of this Article]

Primary amyloidosis

Other conditions

The role of allogeneic bone marrow stem cell transplantation

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