Myeloma cast nephropathy (MCN) is the most common form of myeloma renal disease and frequently progresses to chronic renal failure. It is often precipitated by dehydration, hypercalcemia, and use of diuretics or nons-teroidal anti-inflammatory drugs, all causing a reduction in glomerular filtration. Renal failure is reversible in about 50% of patients.8-10,46 The physical basis for light-chain nephrotoxicity has not been elucidated. The initial finding that the isoelectric point of light chain was the determinant for its nephrotoxicity has not been con-firmed.45 47 Nevertheless, coprecipitation of light chain and Tamm-Horsfall protein in distal tubules leads to obstructing cast formation, tubular atrophy, disruption of the basement membrane, interstitial inflammation and fibrosis and eventually nephrosclerosis, all features characteristic of "myeloma kidney".4648
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