Introduction: Management of Bone Disease and Kidney Failure in Multiple Myeloma

Multiple myeloma (MM) is a neoplastic disease characterized by proliferation and accumulation of B-lymphocytes and plasma cells (PCs), synthesizing monoclonal immunoglobulin (M component, MC) in the bone marrow (BM) or, more rarely, in extramedullary tissues. Clinical signs and symptoms at the onset of MM are varied and typically related to the expansion of the neoplastic mass and/or the production by neoplastic cells of cytokines or other factors and/or the peculiar chemical-physical characteristics of the MC (Rajkumar et al., Lancet Oncol 15:e538–548, 2014). The two most important symptoms, for frequency and severity, are skeletal involvement and renal failure. The pathogenesis of skeletal involvement in MM depends on uncoupling of bone remodeling, with increased osteoclast activity, which is unbalanced by adequate osteoblast function. Imaging plays a very important role in the management of this complication; treatment of bone disease is very important as well. The pathogenesis of renal failure in MM is multifactorial, both related to the MC or parts of it and to additional factors. Despite modern treatment strategies have significantly improved the prognosis of patients with renal failure, the presence of this complication, especially if acute, increases the risk of early mortality and complications. In this book, the pathophysiology, diagnosis, and treatment of both bone disease and kidney involvement are extensively described, in order to enable the reader to best manage these important clinical features.