Over half of all patients with myeloma develop renal insufficiency and it is the second
most common cause of death. The occurrence of acute renal failure in multiple myeloma
is generally considered to be an ominous prognostic sign. A raised blood urea
concentration at presentation is the single most important to a poor prognosis. The
causes of renal impairment in myeloma most usually mentioned include infection,
hypercalcemia, hyperuricemia, hyperviscosity, Bence-Jones proteinuria, Fanconi's
syndrome, plasma cell infiltration of the kidney, amyloidosis, and glomeru-losclerosis.
However, in most cases there is a strong correlation between the occurrence of
Bence-Jones proteinuria and renal failure.
According to light chains pathogenic considerations, all therapeutic measures
attempting to decrease serum light chain concentration may be of primary importance.
Alkylating agents associated with corticosteroids have been shown to be effective in
deducing light chain synthesis and favorably influencing renal disease. Pertoneal dialysis
is rather effective in removing a moderate amount of light chains. However
plasmapheresis is the only therapeutic measure capable of achieving a rapid and
remarkable decrease in serum light chain concentration.
We presented a case of fifty-five-year-old man with acute failure and bleeding
tendencies in refractory multiple myeloma which was successfully treated by repeated
plasmaphereses and chemotherapy consisted of continuous infusion of vincristine,
adriamycin and high dose dexamethasone.
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