Monoclonal Light Chains and the Kidney

Abstract

Monoclonal proteins are most commonly associated with the malignant proliferation of plasma cells, called multiple myeloma (MM), which can cause a variety of renal disorders. Direct structural damage, however, is almost exclusively seen in the presence of light and / or heavy chains. This review provides an overview of kidney diseases in monoclonal disorders. Issues like epidemiology, impact on survival, pathology and pathophysiology will be summarized. Additionally, diagnostic measures and differential diagnosis are discussed. Furthermore, this article focuses on special disease entities that primarily involve glomerula (e.g. amyloidosis, monoclonal immunoglobulin deposition disease) or the tubulointerstitium (e.g. light chain cast nephropathy). Especially the issue of treating light chain cast nephropathy in patients with MM has become a focus of recent in vitro and in vivo research. New treatment options using special hemodialysers have instigated a fundamental discussion about utilizing this technology not only in MM patients with acute renal failure but also in those with reduced glomerular filtration rate due to cast nephropathy. We summarize the current status of treatment options of light chain cast nephropathy. Advantages of traditional compared to recently developed treatments will be discussed as well as modern chemotherapy protocols and the impact on overall survival and kidney function.