Myeloma kidney: pathogenesis and treatment.

Renal failure frequently complicates the course of multiple myeloma. Factors that determine the development of myeloma kidney include a high rate of light chain excretion, biochemical characteristics of light chain, and concurrent volume depletion. There are two main pathogenetic mechanisms; i.e. direct tubular toxicity and intratubular cast formation. Therapeutic measures include chemotherapy, bone marrow or peripheral blood stem cell transplantation, hyperhydration, plasmapheresis, dialysis, solving of hypercalcemia, treatment of anemia with erythropoietin, and avoidance of nephrotoxic drugs and radiocontrast agents. Experimental approach includes administration of colchicines and alkalinization of the urine.