RENAL PATTERNS IN MYELOMA

Abstract

"Myeloma kidney" is a pathologic term descriptive of the changes associated with lamellated protein deposits in the renal tubules of patients with multiple myeloma. Myeloma can produce renal damage by other mechanisms as well, and review of 10 years experience with 30 myeloma patients discloses that renal disease is a common guise under which this neoplasm may masquerade. Illustrative case histories of patients with myeloma are presented and include a man with normotensive azotemia, a 2d with renal tubular acidosis due to renal paramyloid, and a 3d with postoperative hemoglobinuric nephrosis superimposed on "myeloma kidney", and pseudomembranous enterocolitis (staphylococcal) probably related to deficiency in antibody (true gamma globulin). A 4th patient developed malignant hypertension on the basis of renal and arteriolar paramyloidosis secondary to myeloma. In many instances correct diagnosis was not suspected during life, and the underlying myelomatosis was unearthed only because bone marrow study is routine autopsy procedure at this hospital. The 3 mechanisms by which myeloma may produce renal disease are (1) renal tubular occlusion by massive precipitates of myeloma protein. (2) renal amyloidosis, (3) secondary hypogammaglobulinemia, with vulnerability to severe infectious, particularly pyelonephritis. Recent research advances in the study of myeloma are reviewed.