Myeloma kidney: toward its prevention--with new insights from in vitro and in vivo models of renal injury.

Renal involvement in patients with multiple myeloma complicates their treatment and shortens their life span. The main renal lesion is predominantly a tubulointerstitial disease characterized by fibrosis, frequently associated with light chain-containing casts. At present there is no effective treatment for kidney disease associated with multiple myeloma. Recent research highlights the importance of interactions between myeloma light chains and proximal tubule epithelial cells in the pathogenesis of myeloma kidney. Dissecting the cellular and molecular events has identified novel avenues for potential treatment. Among these, pituitary adenylate cyclase-activating polypeptide-38 (PACAP38), a pituitary immune-modulating peptide, has emerged as a promising novel therapy. PACAP38 prevented light chain-induced renal injury patterns in vitro, and in experimental animals in vivo. Further clinical studies are necessary to establish the usefulness of these novel therapies in preserving the kidney function in patients with multiple myeloma.