Renal Disease in Multiple Myeloma
Kitapta bölümler > Diğer · 2012
Yazarlar: Güray SAYDAM, Fahri ŞAHİN, Hatice Demet
Multiple Myeloma - An Overview, Diğer, Uluslararası, 2012, ,
DOI: 10.5772/33149
Özet
Pathogenesis of renal disease in Multiple Myeloma is multifactorial .It is associated with excess production of monoclonal light chains by the neoplastic B-cell clone.Renal lesions occur primarily in tubules; however glomeruli, interstitium and blood vessels may also be involved.Myeloma cast nephropathy (Light Chain Cast Nephropathy -LCCN, Myeloma kidney) is the most prominent type of MM renal involvement and is primarily tubular.Isolated distal or proximal tubular dysfunction and acquired Fanconi Syndrome also may be seen.Glomerular lesions are usually related to AL-amyloidosis and light/heavy deposition disease.Interstitial nephritis and plasma cell infiltration demonstrate the involvement of renal interstitium.Types of pathologic lesions are basically determined by the mutated amino acid sequence of the monoclonal light chain.This was confirmed with LC injected mice that developed the same pattern of renal disease as was seen in the donor MM patient.(Solomon A, Weiss DT, Kattine AA,1991) Autopsy series of patients with myeloma found that the most frequent pathology is LCCN accounts for 40% to 60%, whereas light chain deposition disease and amyloidosis were seen in 5% and7% cases respectively.(Ivanyi B.,1989) In native renal biopsy studies of patients with myeloma and renal disease,40 to 63% had cast nephropathy, 19 to 26% had light-chain deposition disease, 7 to 30% had amyloidosis, and <1% had cryoglobulinemic renal > disease."(Ganewal D.,et al,1992 ve Montseny JJ. et al,1998) Renal biopsy is not indicated many patients for differential diagnosis to concern therapeutic options and estimation of prognosis in patients with the diagnosis of myeloma.(Kidney biopsy is generally not indicated for many of patients)We have tried to summarize the all pathophysiological mechanisms and clinical presentations of renal involvement in MM patients in this chapter.