Renal Dysfunction - Multiple Myeloma Center for Nurses

Renal Dysfunction

Renal Dysfunction

Renal dysfunction is a myeloma-defining event characterized by elevated serum creatinine or impaired creatinine clearance.1

It is caused by overproduction of monoclonal light chains, which damages the kidneys.2,3

Prevalence3,4

  • Between 15% and 40% of patients experience this complication due to hypercalcemia and protein deposition
  • Renal impairment is increasingly reversible due to more effective antimyeloma therapies and improvements in supportive care

Common Signs and Symptoms3

  • Anemia
  • Fatigue
  • Malaise
  • Fluid and electrolyte imbalances
  • Decreased urination

Assessment

Serum creatinine

  • Defined as >2 mg/dL (>177 μmol/L)1

Creatinine clearance

  • Defined as <40 mL/min (volume of plasma cleared of creatinine)1
  • Provides estimation of glomerular filtration rate1
  • Can be measured by 24-hour urine collection3
  • Can be determined via the Cockcroft-Gault equation3

Management3

  • Evaluate associated signs and symptoms
  • Review medications for aggravating therapies
  • Monitor aggravating health conditions, such as diabetes or hypertension
  • Assess light-chain proteinuria to help distinguish between nonparaprotein-related causes and light-chain–induced renal impairment

For Your Patients3

  • Explain the symptoms of renal dysfunction and the importance of reporting them
  • Encourage appropriate patients to engage in:
    • Exercise
    • Weight control
    • Smoking cessation
    • Adherence to blood pressure and blood sugar medications
  • Discuss how renal function may affect the ability to receive certain antimyeloma treatments

References:

  1. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548.
  2. Tricot G. Clinical manifestations. In: Hoffman R, Furie B, Benz EJ, McGlave P, Silberstein LE, Shattil SJ. Hematology: Basic Principles and Practice. 5th ed. New York, NY: Churchill Livingstone; 2008.
  3. Faiman B, Doss D, Colson K, et al; and the International Myeloma Foundation Nurse Leadership Board. Renal, GI, and peripheral nerves; evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 suppl):19-36.
  4. Dimopoulos DA, Terpos E, Chanan-Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol. 2010;28(33):4976-4984.
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