What can precipitate AKI in myeloma?
Patients with myeloma are particularly vulnerable to factors that cause volume depletion or sudden reductions in glomerular filtration. This is because these changes reduce tubular flow and increase the exposure of the tubule to high LC concentrations. Classically, hypercalcemia related to plasma cell-mediated bone destruction and the release of calcium causes volume depletion and vasoconstriction, and is present in around 15% of patients at diagnosis. Non-steroidal agents prescribed for bone pain and intravenous contrast agents used for diagnostic investigations also abruptly reduce glomerular filtration and are associated with AKI, which is sometimes irreversible. Sepsis resulting from chemotherapy and reduced Ig levels may cause AKI.
