Behandlung von nephrologischen und ossären Komplikationen beim multiplen Myelom

Both renal and osseous complications are common types of end organ damage in multiple myeloma (MM).

This study aims to present treatment options in the case of nephrological or osseous complications in MM.

The work is based on a literature search of current international studies and review articles.

Renal and osseous complications are common forms of end organ damage in MM. Kidney damage in MM may be caused by toxic effects of free light chains that form aggregates in the tubules and lead to functional disorders, including acute or chronic kidney failure. Other diseases, such as amyloid light chain (AL) amyloidosis or monoclonal immunoglobulin deposition disease (MIDD), can also cause kidney damage. Treatment aims to preserve and/or improve kidney function and avoid dialysis. Supportive measures such as fluid replacement and avoidance of nephrotoxic substances are essential. Mechanical procedures such as (high-cutoff) hemodialysis support systemic anti-MM drug therapy. Multiple myeloma-associated bone disease results from an imbalance between osteoclast activity, which is enhanced by MM cells, and inhibited osteoblast activity. This leads to bone resorption, lytic lesions, and fractures. Whole-body CT, possibly supplemented by MRI or positron-emission tomography (PET)/CT, is used today. Treatment includes bisphosphonates, such as zoledronate and pamidronate, and denosumab to inhibit bone resorption. Rare side effects, such as kidney damage or osteonecrosis of the jaw, require special precautions. Pathological fractures can be surgically stabilized, and spinal cord compression requires decompression and radiation treatment.