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NDT Advance Access originally published online on October 13, 2006
Nephrology Dialysis Transplantation 2006 21(12):3601-3602; doi:10.1093/ndt/gfl578
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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

Kidney biopsy in myeloma

Email: cmagee{at}partners.org

Sir,

In their comprehensive review of myeloma-associated kidney disease, Haubitz and Peest [1] state that ‘In many patients a kidney biopsy is essential for a decision on individual treatment’

The risk of serious bleeding due to kidney biopsy in patients with myeloma is likely to be increased because myeloma-associated with a bleeding diathesis (as the authors note). Indeed, the largest and most recent trial of plasmapheresis for myeloma-associated kidney failure did not specify kidney biopsy as an inclusion criterion because of concerns about the risks vs benefits of the procedure [2].

Can the authors specify how a biopsy result will—in many patients—sufficiently alter management beyond standard measures (such as volume expansion, control of hypercalcaemia, chemotherapy) to justify its increased risk? One answer might be that demonstration of the presence of acute cast nephropathy would prompt initiation of plasmapheresis. However, the largest trial of myeloma-associated acute renal failure did not show a clear benefit with this invasive therapy [2].

Conflict of interest statement. None declared.

Colm C. Magee

Brigham + Women's
Hospital - Renal Division
75 Francis Street, Boston
MA 02115, USA

References

  1. Haubitz M and Peest D. (2006) Myeloma—new approaches to combined nephrological-haematological management. Nephrol Dial Transplant 21:582–590.[Free Full Text]
  2. Clark WF, Stewart AK, Rock GA, et al. (2005) Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 143:777–784.[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/12/3601-a    most recent
gfl578v1
Right arrow Alert me when this article is cited
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Right arrow Articles by Magee, C. C.
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