When kidney biopsy mandatory in myeloma with AKI?
In patients with biochemically proven myeloma and AKI who do not show a prompt response to hydration and the correction of precipitants, a diagnostic kidney biopsy to determine the cause of kidney injury is suggested because of the variability in kidney etiology and the importance of ensuring a correct histologic diagnosis. In patients with an excess of albuminuria rather than the expected LC proteinuria, a biopsy is necessary to establish the presence of amyloidosis or other glomerular disorders associated with LCs. The type and stage of disease (especially the degree of tubular fibrosis) may influence the choice of chemotherapy and the consideration of adjunctive treatments such as high cut-off (HCO) dialysis. Sometimes, the diagnosis of myeloma is made or suggested by the kidney biopsy as the first investigation and subsequently confirmed with protein chemistry.
