Multiple myeloma and renal failure; [Multipl miyelom ve böbrek yetersizliǧi]
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Date
2001
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Abstract
MM should be suspected in every patient with acute renal failure of uncertain ethiology because in this situation a prompt therapy should be administered in order to prevent sustained renal failure. Patients with known MM should be investigated for potential renal impairment. The MM therapy includes two major sides: General measures and chemotherapy. Preventive measures against dehydration, hypercalcaemia, infection, septicaemia and the use of nephrotoxic agents are the backbones of the general approach to MM. The early mortality of MM patients with renal failure is up to 30%. This is due mainly to infection and septicaemia and is favoured by the immunosupsressive effects of myeloma per se, of renal failure, and of the administration of corticosteroids and cytostatic drugs. Prevention, early diagnosis and optimal therapy for infections are recommended. Chemotherapy should be started as soon as possible. To achieve fast reduction in the myeloma protein load we recommend VAD chemotherapy for patients up to the age of 65 years. Patients with renal failure should be treated in hospital to detect infections at an early stage in order to start antibiotic therapy. Patients older than 65 years should be treated with cyclophosphamide plus prednisone or melphalan plus prednisone, because the incidence of complications caused by high-dose pulsed immunosuppressive glucocorticoid therapy is high in this age bracket. In addition, chemotherapy with alkylating agents could induce leucocytopenia in MM patients. Antibiotic prophylaxis is recommended for patients with MM at the time of chemotherapy. Factors affecting the recovery of renal function are the degree of renal failure, the presence of hypercalcaemia and the amount of protein excreted. Effective treatment of renal failure in combination with myeloma therapy will reduce adverse events and prolong survival.
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Keywords
alkylating agent , corticosteroid , cytostatic agent , glucocorticoid , immunosuppressive agent , melphalan , prednisone , acute kidney failure , antibiotic prophylaxis , antibiotic therapy , disease association , early diagnosis , hospital infection , human , hypercalcemia , immunosuppressive treatment , infection , kidney function , leukopenia , multiple myeloma , proteinuria , review , septicemia , survival