Cast nephropathy (myelomnyre) is the main nyreaffeksjonen by multiple myeloma. Free light chains are filtered freely filtrasjonsbarrieren. At high concentrations, the free light chains precipitated as cylinders in tubules. This initiates the immune response and acute renal failure occurs. At histopathological examination is found cylinders in tubules (Picture Helge). Treatment consists of treating the underlying disease to reduce production of light chains. Special filters with large pores have been attempted in patients requiring dialysis to remove the light chains from the circulation, but the treatment is currently experimental.
Severe hypercalcemia may occur in multiple myeloma as a result of skjelettdestruksjonen. Hypercalcemia seems diuretic, and patients may become very dehydrated with prerenal kidney failure and eventually acute tubular necrosis spreads and goals. Rehydration is important measures in addition to lowering serum calcium by giving bisphosphonates and thus build calcium back into bones.
AL amyloidosis can also afflict the kidney and results in proteinuria that may cause nephrotic syndrome. Treatment consists of treating the underlying disease.
Other glomerular and tubular affections of multiple myeloma may occur and traced by renal biopsy. A biopsy of myelomatosepasienter with kidney involvement is therefore endeavored to get the final diagnosis.