NDT Advance Access originally published online on January 5, 2006
Nephrology Dialysis Transplantation 2006 21(3):582-590; doi:10.1093/ndt/gfi318
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Editorial Review
Myeloma – new approaches to combined nephrological–haematological management
1 Department of Nephrology, 2 Department of Haematology, Haemostaseology, and Oncology, Hannover Medical School, Hannover, Germany
Correspondence and offprint requests to: Prof. Marion Haubitz, Department of Nephrology, Hannover Medical School, Hannover, Germany. Email: haubitz.marion@mh-hannover.de
Keywords: AL amyloidosis; cast nephropathy; high-dose chemotherapy; kidney transplantation; light chain deposition disease; multiple myeloma
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Introduction |
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Multiple myeloma (MM) is a haematopoietic malignancy of terminal differentiated clonal plasma cells. The clinical symptoms are caused by diffuse or multilocular infiltration of the bone marrow with osteolysis and suppression of the normal haematopoesis, as well as by the production of monoclonal immunoglobulins or fragments (light chains or heavy chains). The incidence is approximately 3–4/100 000/year. MM is a disease of the elderly. Approximately 15% of patients are aged 60 years or younger and a further 15% between 60 and 65 years. Fewer than 2% of the patients are younger than 40 years at diagnosis. This age distribution has implications for the population eligible for specific types of treatment, such as high-dose therapy and stem cell transplantation.
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Diagnosis |
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The presenting features include symptoms of bone disease, typically unexplained backache and sometimes fractures, anaemia, renal insufficiency of different degrees, oedema (caused by a nephrotic syndrome and/or cardiac failure), hypercalcaemia, severe bacterial
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Cast nephropathy |
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Histology |
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Clinical manifestation |
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Treatment and prognosis |
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Conventional chemotherapy
High-dose chemotherapy
Allogeneic bone marrow or PBSC transplantation
New developments
Supportive therapy
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AL amyloidosis |
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Histology
Clinical manifestation
Treatment and prognosis
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Light-chain deposition disease |
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Histology
Clinical manifestation
Therapy and prognosis
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Renal replacement therapy and transplantation in patients with multiple myeloma |
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