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NDT Advance Access published online on January 5, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi318
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received November 1, 2005
Accepted November 14, 2005

Editorial Comment

Myeloma - new approaches to combined nephrological-haematological management

Marion Haubitz 1 * and Dietrich Peest 2

1 Department of Nephrology, Hannover Medical School, Hannover, Germany
2 Department of Haematology, Haemostaseology, and Oncology, Hannover Medical School, Hannover, Germany

* To whom correspondence should be addressed.
Marion Haubitz, E-mail: haubitz.marion{at}mh-hannover.de



  Abstract

In multiple myeloma (MM) kidney involvement is seen in about 50% of the patients, but completely different diseases are found. Nearly one-third of the patients develop cast nephropathy, less often AL amyloidosis and light-chain disease are found. Renal impairment can also be aggravated or even attributed to other factors like hypercalcaemia, dehydration, infection or the effects of nephrotoxic drugs. Effective and high-quality care requires an interdisciplinary approach and a combined nephrological and haematological management is therefore necessary. Several treatment options have been proposed (conventional chemotherapy, high-dose chemotherapy with autologous stem cell support, allogeneic stem cell transplantation and others). However, controlled trials are rare. An adequate diagnostic work-up concerning the plasma cell clone and the renal manifestation is essential for the treatment decision.

Keywords: AL amyloidosis; cast nephropathy; high-dose chemotherapy; kidney transplantation; light chain deposition disease; multiple myeloma.
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