Insuficiência renal em pacientes com mieloma múltiplo: uma revisão narrativa

Abstract

Renal insufficiency is one of the most common complications in multiple myeloma. According to the most recent data from the North American literature, up to 12% of patients with the disease may require renal replacement therapy at some point, either due to acute kidney injury or chronic kidney disease. The main mechanism of renal insufficiency in these patients is "myeloma kidney," caused by the excretion of light chains, which results in damage to the renal tubules. Other mechanisms include the accumulation of light chains in tissues and acquired Fanconi syndrome. Factors such as hypercalcemia, hyperuricemia, dehydration, hyperviscosity, and the use of nephrotoxic drugs can aggravate and precipitate renal insufficiency. Supportive treatment is essential for all patients, and when renal function cannot be reversed, dialysis treatment should be considered. Specific treatment for multiple myeloma in patients with renal insufficiency is crucial and may positively influence survival. The most recommended initial chemotherapy is the combination of VAD or cyclophosphamide with dexamethasone. For patients under 60 years old and in good general condition, high-dose chemotherapy and autologous transplantation may be considered, while for older patients, the chances are lower due to the available restrictions and interventions, as well as a higher likelihood of side effects from conventional therapies. In light of this reality, it is clear that more research and attention in the clinical management of patients, especially those who are older and have fewer therapies and interventions available, are necessary. This highlights the importance of early diagnosis and collaboration between hematologists and nephrologists, as proper follow-up can significantly impact the quality of life and survival of these patients. Ongoing research is crucial to develop faster diagnoses, more effective treatments, and, in the future, a cure for the disease. Articles related to this topic were reviewed on platforms such as LILACS, PubMed, Google Scholar, and SciELO, and articles that could provide an accurate and objective overview of the current situation of these patients were selected