Renal Complications in Hematologic Malignancies
Ahmed Ibrahim Soliman Dewek;
Abstract
Hematologic neoplasia can affect kidneys in a number of ways, including direct invasion. In addition glomerulopatheis, tubulointerstitial disease, and fluid and electrolyte abnormalities can occur. These disorders may be related to the disease or be a complication of treatment. Renal failure can occur as a result of urinary tract obstruction by enlarged retroperitoneal lymph nodes. These immunosuppresed patients may develop severe infections and acute renal failure may result from some of these infections. Treatment of infections with nephrotoxic antibiotics is often complicated by acute renal failure. Renal injury may be a consequence of therapy directed to patients neoplasm. Often, renal injury represents the dose limiting factor in such therapies. Hence early diagnosis and effective management of these complications is necessary to improve survival and prognosis in these patients.
Multiple myeloma (MM) is a diffuse neoplasm of bone marrow plasma cells that produces several diverse effects on kidneys. It exerts its effects locally (osteolytic bone lesions and impaired hematopoieses) and systemically by the actions of the abnormal immunoglobulin or light chain on the kidney, culminating in acute or chronic renal failure. Deposit of lambda light chain results in amyloidosis and nephrotic syndrome. The proximal tubular dysfunctions associated with immunoglobulin deposits are also common. Renal disease is the presenting feature in vast majority of patients before establishing the diagnosis of MM. A small number of patients are referred for the treatment of a renal disease after the diagnosis of MM is already established.
Renal impairment is a common and severe complication of MM. High-dose dexamethasone therapies are highly active in myeloma patients with renal impairment. Available data support the safety and efficacy of bortezomib-based therapies in this setting, so bortezomib + dexamethasone is the recommended treatment for myeloma patients with renal impairment of any grade. Lenalidomide is a feasible and effective treatment option for patients with mild to moderate renal impairment, but it should be administered at the recommended reduced dose based on renal function. Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortezomib can be administered without additional toxicity.
The development of acute renal failure in patients with lymphoma can at times present a major clinical problem, and generally develops as a direct effect of the lymphoma, e.g. obstruction of the ureters, or renal artery or vein thrombosis. Other more indirect causes of renal failure include hypercalcemia, sepsis, hemolysis, and paraproteinemia with deposits of paraprotein. Cryoglobulinemia, amyloid formation, nephrosis or nephritis may also be encountered. Therapy-related causes of renal failure include radiation nephritis and tumor lysis syndrome, while therapeutic agents or antibiotics may also cause renal damage.
Multiple myeloma (MM) is a diffuse neoplasm of bone marrow plasma cells that produces several diverse effects on kidneys. It exerts its effects locally (osteolytic bone lesions and impaired hematopoieses) and systemically by the actions of the abnormal immunoglobulin or light chain on the kidney, culminating in acute or chronic renal failure. Deposit of lambda light chain results in amyloidosis and nephrotic syndrome. The proximal tubular dysfunctions associated with immunoglobulin deposits are also common. Renal disease is the presenting feature in vast majority of patients before establishing the diagnosis of MM. A small number of patients are referred for the treatment of a renal disease after the diagnosis of MM is already established.
Renal impairment is a common and severe complication of MM. High-dose dexamethasone therapies are highly active in myeloma patients with renal impairment. Available data support the safety and efficacy of bortezomib-based therapies in this setting, so bortezomib + dexamethasone is the recommended treatment for myeloma patients with renal impairment of any grade. Lenalidomide is a feasible and effective treatment option for patients with mild to moderate renal impairment, but it should be administered at the recommended reduced dose based on renal function. Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortezomib can be administered without additional toxicity.
The development of acute renal failure in patients with lymphoma can at times present a major clinical problem, and generally develops as a direct effect of the lymphoma, e.g. obstruction of the ureters, or renal artery or vein thrombosis. Other more indirect causes of renal failure include hypercalcemia, sepsis, hemolysis, and paraproteinemia with deposits of paraprotein. Cryoglobulinemia, amyloid formation, nephrosis or nephritis may also be encountered. Therapy-related causes of renal failure include radiation nephritis and tumor lysis syndrome, while therapeutic agents or antibiotics may also cause renal damage.
Other data
| Title | Renal Complications in Hematologic Malignancies | Other Titles | المضاعفات التي تحدث للكلي في حالات أورام الدم | Authors | Ahmed Ibrahim Soliman Dewek | Issue Date | 2014 |
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