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BioMed Research International
Volume 2014 (2014), Article ID 167125, 10 pages
Review Article

Pathogenesis of Renal Failure in Multiple Myeloma: Any Role of Contrast Media?

1Laboratory Medicine Service, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University-Hospital San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy
2Amyloidosis Research and Treatment Center, Clinical Chemistry Laboratories, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
3Department of Molecular Medicine, University of Pavia, Italy

Received 1 November 2013; Revised 13 March 2014; Accepted 13 March 2014; Published 30 April 2014

Academic Editor: Michele Andreucci

Copyright © 2014 Michele Mussap and Giampaolo Merlini. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The spectrum of kidney disease-associated monoclonal immunoglobulin and plasma cell malignancies is remarkably broad and encompasses nearly all nephropathologic entities. Multiple myeloma with kidney impairment at presentation is a medical emergency since the recovery of kidney function is associated with survival benefits. In most cases, kidney impairment may be the first clinical manifestation of malignant plasma cell dyscrasias like multiple myeloma and light chain amyloidosis. Multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media. The risk is increased by comorbidities such as chronic kidney disease, diabetes, hypercalcemia, dehydration, and use of nephrotoxic drugs. Before the administration of contrast media, the current recommended laboratory tests for assessing kidney function are serum creatinine measurement and the estimation of glomerular filtration rate by using the CKD-EPI equation. The assessment of Bence Jones proteinuria is unnecessary for evaluating the risk of kidney failure in patients with multiple myeloma, since this test cannot be considered a surrogate biomarker of kidney function.