[Lawrence]

Kidney failure and multiple myeloma

by Lawrence on Thu Jan 28, 2016 11:46 am

I was diagnosed with kidney disease (focal segmental glomerulosclerosis (FSGS) - not otherwise specified (NOS) variant, and acute proteinuria) in May 2013 at Bangalore, India. The repeat kidney biopsy done in April 2014 in Canada confirmed the diagnosis. The recent serum creatinine is 520 Ummol/L, eGFR is 10, random urine albumin is 3315 mg/L and albumin-creatine ratio is 392 mg/mmol. The protein in urine is 5.0 mg/L. I am taking epo (ESA) to deal with anaemia. I am getting ready for peritoneal dialysis.

With regard to my multiple myeloma, bone marrow biopsy results showed that my monoclonal plasma cells have gone up from 1.5% in June 2014 to 15% in November 2015. The kappa free light chains have increased form 800 to 1368, Current total beta amount 24.3 g/L and free kappa-lambda ratio is 69.24. Skeletal scan done a year ago did not show any lesions.

Two oncologists I consulted suggested that I have plasma cell cancer and require chemo­therapy. However, a myeloma specialist whom I consulted last month thinks that it might be smoldering multiple myeloma, as I do not have any bone pain. He ordered an MRI to help with making decisions about treatment.

The 3-4 nephrologists I consulted believe that my kidney disease is due to multiple myeloma, However, the myeloma specialist thinks that both diseases may be unrelated because the kidney biopsy results showed that there were other protein cells in the glomeruli along with a few related to multiple myeloma. So, myeloma might not be the cause of kidney failure.

I am all confused and tired of living with uncertainty. Nephrologists say that I may not be a candidate for kidney transplant, unless and until am cured of myeloma.

Please provide me your opinion regarding:

1. Could myeloma be the cause of my kidney disease?
2. Is it possible to be on dialysis and undergo chemo for myeloma at the same time? Is it risky? How good is my prognosis?
3. Some research papers suggest that kidney transplant helps patients to deal with myeloma treatment. Hence it is better to go for kidney transplant ASAP. What would you suggest?

Last edited by Lawrence on Thu Jan 28, 2016 9:52 pm, edited 1 time in total.

[Nancy Shamanna]

Re: Kidney failure and multiple myeloma

by Nancy Shamanna on Thu Jan 28, 2016 3:32 pm

Hi Larry,

Welcome to the forum. It sounds like you do have two of the criteria in the CRAB rule of thumb about myeloma, i.e., anemia (A), and renal issues (R). I am not a doctor, though, and would recommend that you talk to the myeloma specialist and the other oncologists again about your health issues. The dividing line between smoldering multiple myeloma and active myeloma seems difficult to differentiate sometimes too. Bone pain alone is not the only measure of myeloma. The CRAB symptoms are

C - excess Calcium in the blood
R - Renal complications
A - Anemia
B - Bone involvement.

Myeloma can be the cause of kidney disease, to answer your first question. The light chains of antibodies, which are produced in large excess by the monoclonal cancer cells, are difficult for the kidneys to process, and can cause problems that way. Anemia can also be caused by the cancer cells crowding out the healthy blood cells, such as the red blood cells. The bone marrow biopsy can show this.

Good luck and hope you can get some medical clarifications soon.

[Lawrence]

Re: Kidney failure and multiple myeloma

by Lawrence on Fri Jan 29, 2016 12:01 am

Thanks Nancy for taking time to provide your views on my questions. The CRAB yardstick is helpful. I will wait for the MRI and consult with the myeloma specialist. Having either kidney failure or multiple myeloma is very hard, but living with both these very demanding diseases is even harder. It limits treatment options, I guess.

[Kay]

Re: Kidney failure and multiple myeloma

by Kay on Sat Apr 02, 2016 1:03 am

Larry,

I'm sure your doctors have reviewed your medications (if you take several) to see if one might be part of your kidney problems.

I was taking an NSAID prescription for osteoarthritis and last fall my eGFR dropped to 32. I stopped the NSAID and my eGFR rose to 54 and 49 for a couple of months. I restarted the NSAID once a day instead of twice/day, hydrated well, and my eGFR stayed at 49. I found out that there was a micronized version of my NSAID that was a lower dose. I tried this for 2 weeks and was retested and my eGFR was 26 and stopped the med. I just had a blood draw this week; so I don't know at this point what my kidney function is.

Until I stopped this medication, I feel sure my hematologist thought my low kidney function was caused by myeloma, but I see now that it is medication related.

Kay

[jhorner]

Re: Kidney failure and multiple myeloma

by jhorner on Mon Apr 04, 2016 12:31 pm

Hello Lawrence,

Have your kidney's been biopsied for "amy­loid­osis" specifically? There is special staining re­quired and typically only larger institutions perform this pathology. If they found excess protein in addition to myeloma in your kidney's it might be amyloid protein - also a plasma cell protein. Amy­loidosis is a rare complication of myeloma or it can present as the primary disease and most often affects the kidneys and the lungs.

If your kidneys have not been tested then I would think this is a necessary first step. Often enough, 70% of the time, it can be diagnosed with a skin biopsy (fat pad biopsy) but since it has a 30% false negative risk, I would push for the kidney biopsy for amyloid if it the fat pad is negative.

I'm sorry for your anguish. Good luck.
J