Myeloma kidney is a life-threatening consequence of severe kidney damage caused by a cancer of the hematopoietic system. It develops after severe toxicity from proteins produced by a disease called multiple myeloma. The secretion of these protein cylinders directly weakens the renal tubules, which can very quickly lead to acute kidney failure.
What is a myeloma kidney?
Multiple myeloma is also known as plasmacytoma. It is characterized by the proliferation of plasma cells in the blood that are responsible for producing antibodies. These degenerated plasma cells give rise to cancer cells and produce antibodies that are merely identical to themselves. Multiple myeloma can progress slowly, but it can also be very fast and aggressive. It can give rise to what is called myeloma kidney.
Causes
Plasmocytoma is considered the most common malignant tumor in bone marrow and bone. However, it usually occurs after the age of 40 years. At the age of 60, the disease accumulates, more in men than in women. Four to six new cases per 100,000 inhabitants per year have been measured. About one in ten hematologic cancers is multiple myeloma. According to estimates, about 75,000 people worldwide suffered from plasmacytoma in 2015. Medical research has not yet been able to verify exactly which factors lead to myeloma kidney. Heredity is thought to play some role. There are also assumptions that ionizing radiation may have an important influence on the development of the disease. Equally possible is a damaging influence of the pesticide glyphosate, which comes about through diet.
Symptoms, complaints, and signs
After a malignant plasma cell has clonally proliferated, it damages the bone marrow and negatively affects hematopoiesis. Gradually, the affected bone may be destroyed and degraded. These massive bone changes are prominent in about 60 percent of patients. In addition, the malignant cells form defective, very aggressive antibodies or antibody parts (light chains), which cause further complications of the disease in the body. The natural immune defense is thus severely impaired. Major tissue deposits can lead to serious functional failures of various organs. These include kidney failure, but also severe irregularities in overall blood flow. Because the protein content increases, the blood becomes much more viscous. The smallest blood vessels can easily become clogged and the brain in particular is only poorly supplied with blood. Initially, therefore, those affected initially experience disturbances in hearing and vision or slight fainting spells. Primarily, the unnatural growth of plasma cells leads to bone pain and later to slight bone fractures. The calcium in the blood increases sharply due to the release from the bone. In return, the red blood cells formed in the bone marrow decrease dramatically.
Diagnosis and course of the disease
The diagnosis can often be made only under unexplained conditions, because the condition leads far beyond damage to the kidney. In the early stages of multiple myeloma, misdiagnosis sometimes occurs because kidney hypothermia or rheumatism, sprain, or bone decalcification (osteoporosis) are suspected behind the symptoms that develop. The examination of the blood reveals a so-called fall of the white blood cells. Their proportion in the blood decreases at a strikingly high rate. The blood count often reveals considerable anemia. The number of platelets can also decrease considerably. In patients with already progressive bone loss, the calcium level increases unnaturally. Possible damage to the kidney can be relatively easily detected by altered kidney values. Due to the lack of antibodies caused by the malformations of the plasma cells, the patients’ susceptibility to various infections increases. This is often accompanied by a general feeling of physical weakness and a more or less marked loss of weight. Headaches, nausea, dizziness, and a debilitating drowsiness are also often encountered. The light chains (antibody parts) resulting from the excessive proliferation of the diseased plasma cells are often deposited in the renal corpuscles and renal tubules.This leads to increased excretion of protein in the urine, which is then missing in the blood. Because kidney dysfunctions become noticeable, acids, for example, are excreted at reduced levels. In contrast, deficiencies of phosphate, glucose, uric acid, and amino acids develop.
Complications
Myeloma kidney is a life-threatening disease. If it is not treated directly, the worst case scenario can lead to renal failure and ultimately premature death of the patient. The life expectancy of the affected person is significantly reduced by this disease. The patient’s immune system is also significantly weakened, so that inflammations and infections occur more frequently. In addition, the internal organs can be severely damaged and their function can decline. The blood supply to the body is irregular and there is also a greatly reduced blood supply to the brain. It is not uncommon for those affected to lose consciousness and may also injure themselves. Furthermore, myeloma kidney leads to bone fractures and thus to a strong reduction of the patient’s quality of life. Reduced blood flow to the brain can also lead to paralysis and irreversible damage to the entire body. The treatment itself is performed by chemotherapy or by stem cell transplantation. However, chemotherapy can cause various side effects. Usually, the treatment can limit the symptoms, but it cannot solve them completely, so the patient’s life expectancy is reduced by the myeloma kidney in any case.
When should you see a doctor?
Sufferers who are already undergoing medical treatment for kidney damage should see a doctor for a follow-up visit if their symptoms increase or if their general health continues to deteriorate. In addition to the scheduled check-ups, a visit to the doctor is necessary in case of pain, disorders of the immune system, an increased susceptibility to infections or a decrease in performance. If there are disturbances of consciousness or a loss of consciousness, an ambulance service is required. First aid measures must be taken to ensure the survival of the affected person. General dysfunctions of the organism are alarming and must be presented to a doctor immediately. Therefore, if there is a decrease in vision or hearing, action must be taken. If there are abnormalities in the urine, discoloration, changes in quantity or odor, a physician should be consulted. Fatigue, a rapid onset of fatigue and an increased need for sleep are signs of an irregularity. If headaches, a loss of weight, and circulatory problems occur, a physician should be consulted. A decrease in concentration and attention, apathy, and withdrawal from social life should be discussed with a physician. Nausea, unsteadiness of gait, and dizziness are also unusual and should be clarified. Pale skin, cold fingers and toes, and a quick sensation of cold may indicate a health condition that needs to be treated.
Treatment and therapy
A basic cure for multiple myeloma is not possible with the medical procedures known to date. If no symptoms are yet apparent, the course of the disease is initially monitored. This includes regular examinations of the bone marrow and various laboratory tests. Drug therapy or anti-cancer therapy is only initiated when significant bone changes occur. Nowadays, the patient’s condition can be kept stable for six to ten years with several possible treatment methods, and his quality of life can be maintained at an acceptable level. Chemotherapy is carried out in the classical way, but the side effects can be mitigated very effectively with the help of the latest drugs. The tendency of the malignant cells to divide can also be blocked conventionally with localized radiation therapy. Furthermore, a so-called autologous stem cell transplantation is possible, in which stem cells from the patient’s own bone marrow are used. They can regenerate hematopoiesis after a short time. Much less frequently, allogeneic stem cell transplantation is used, in which a completely new hematopoietic system is formed using foreign stem cells.Here, however, the risk of rejection must be suppressed over a period of about one year with the help of drugs. In older age, however, stem cell transplants are not suitable.
Outlook and prognosis
Myeloma kidney can be treated relatively well. The exact prognosis depends on a variety of factors. First, it is important to know whether the condition occurs in conjunction with chronic kidney disease or as a disease in its own right. The prognosis is positive if treatment is initiated early. In particular, myeloma kidney due to glomular light chain disease can be well treated by means of appropriate drugs. In patients with AL amyloidosis, the prognosis is worse because the deposits remain in the body for a long period of time. In the worst case, kidney failure occurs, resulting in the patient’s death. If left untreated, myeloma kidney often takes a fatal course. The patient experiences increasing discomfort, which eventually leads to organ failure. Treatment must then be given immediately, otherwise the patient will die as a result of the myeloma kidney and the resulting kidney failure. Patients have a limited life expectancy. The prognosis can be improved by early consultation with a nephrologist or other specialist who can initiate treatment according to the symptoms. If this is done in time, the quality of life can be preserved. Nevertheless, long-term complaints may occur, which must be treated individually. Above all, the typical symptoms of poisoning must be treated comprehensively.
Prevention
Since the causes of myeloma kidney could not be clarified so far, there are no measures for prevention. In principle, contact with known risk factors such as ionizing radiation or pesticides and other carcinogenic substances should be avoided.
Follow-up
In most cases, very few and limited measures of direct aftercare are available to the patient with myeloma kidney, so the primary need for this disease is rapid and, above all, early diagnosis. Therefore, affected individuals should seek medical attention at the first symptoms and signs of the disease in order to prevent the occurrence of other complications and symptoms. The earlier a doctor is consulted, the better the further course of the disease usually is. In most cases, myeloma kidney patients are dependent on chemotherapy, which can alleviate the symptoms. During therapy, comprehensive support from one’s family is also very important in order to prevent depression and other psychological upsets. Most of those affected are dependent on the care of other people in their daily lives. Regular check-ups and examinations by a doctor are also very important in order to detect and treat further symptoms at an early stage. The myeloma kidney thereby reduces in most cases the life expectancy of the patient and can thereby also not be completely healed again.
What you can do yourself
Myeloma kidney cannot be treated causally so far. The most effective self-help measure focuses on relieving symptoms. The patient should consult closely with the doctor and follow the doctor’s instructions to avoid complications. Pain can often be reduced by natural remedies such as valerian or arnica. The typical feeling of illness can be alleviated by moderate exercise and an adapted diet. During and after radiation therapy, rest and bed rest apply. The patient must take the necessary measures to support healing and exclude risks. This can be achieved by identifying any risk factors. Here, a complaints diary can be drawn up in cooperation with the physician. After treatment has been completed, further preventive examinations are indicated. The affected person should regularly visit a specialist clinic for kidney disease so that the organ can be examined for possible recurrences. If unusual symptoms or discomfort develop, the physician must be informed. Since myeloma kidney is often a long-term disease that places considerable stress on the affected person, psychological counseling is also useful to accompany medical treatment. If desired, the therapist can also establish contact with a self-help group for chronically ill patients.
