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Writer's picturePolygon Health Team

Multiple Myeloma Kidney Hematoma

Updated: Oct 27

Multiple Myeloma Kidney Hematoma









One of Multiple myeloma's (a rare blood cancer) most severe complications is kidney damage. For some patients, this damage can lead to a rare but serious condition known as a kidney hematoma, a blood collection in the kidney that can pose serious health risks to patients. In this blog article, we'll explore the link between multiple myeloma and kidney hematomas. We will dive into their causes, symptoms, diagnostic approaches, and treatment options, to provide a clear understanding for those affected by multiple myeloma. But first, if you are a multiple myeloma patient or caregiver, then go to Patient Connect. Patient Connect is designed to bring together patients and caregivers on similar health journeys, offering valuable resources based on their personal stories.



The Impact of Multiple Myeloma on Kidney Health


Kidney damage is a frequent complication for patients with multiple myeloma, with studies estimating that between 20% and 40% of newly diagnosed patients experience some degree of kidney impairment. The primary cause of kidney damage in these patients is the overproduction of abnormal proteins, such as immunoglobulin light chains, which are difficult for the kidneys to filter and can lead to what is known as "myeloma kidney." These light chains clog the kidneys, reducing their ability to filter blood efficiently, causing symptoms like fatigue, nausea, and swelling.


In addition to light chain overproduction, multiple myeloma can also lead to hypercalcemia (high calcium levels in the blood), a condition that can worsen kidney function. Studies have shown that up to 30% of patients with multiple myeloma develop hypercalcemia, putting additional stress on the kidneys and making patients more susceptible to kidney-related complications, including hematomas.


What is a Kidney Hematoma?


A kidney hematoma is a collection of blood outside the kidney's blood vessels. Although hematomas can occur in various organs, kidney hematomas are particularly concerning in multiple myeloma patients due to the existing kidney damage. When kidney blood vessels are compromised, they become more prone to leakage, causing blood to accumulate and form a hematoma. Symptoms can include flank pain, blood in urine, decreased urine output, and even nausea. A kidney hematoma can result from trauma, but in multiple myeloma patients, other factors often contribute to its development.


Why Kidney Hematomas Occur in Multiple Myeloma Patients


Multiple factors can increase the risk of kidney hematomas in patients with multiple myeloma, and these factors are often interconnected:


  1. Increased Bleeding Tendency: Multiple myeloma patients frequently have a lower-than-normal platelet count (thrombocytopenia), a condition that impairs blood clotting and increases the likelihood of bleeding. Thrombocytopenia is especially common in patients undergoing certain chemotherapy treatments, and it contributes significantly to the risk of hematoma.


  2. Kidney Damage and Vulnerability: As myeloma progresses, kidney damage can accumulate. The compromised kidney tissues are more fragile and prone to developing hematomas, especially under physical stress or certain medications that affect blood pressure and clotting.


  3. Treatment Complications: Treatments for multiple myeloma, such as chemotherapy, can increase bleeding risks, while procedures like kidney biopsies carry a small risk of creating a hematoma. Additionally, medications that reduce calcium or protein levels to protect the kidneys can sometimes have side effects that heighten bleeding tendencies.


  4. Physical Trauma: Although less common, physical injury to the kidney area can also lead to hematomas, especially in multiple myeloma patients with weakened kidney structures.


Recognizing the Symptoms of Multiple Myeloma Kidney Hematoma


Kidney hematomas can be difficult to identify since their symptoms often overlap with general kidney impairment symptoms common in multiple myeloma. However, several specific signs suggest a hematoma:


  • Persistent flank pain or tenderness on one side


  • Blood in the urine (hematuria), which may appear as red, pink, or tea-colored


  • Reduced urine output, which may signal impaired kidney function


  • Fatigue and weakness, common in multiple myeloma but more pronounced with kidney complications


  • Nausea and vomiting, which can occur if the hematoma causes kidney function to decline further


Early recognition of these symptoms can prevent complications, so patients with multiple myeloma should report any new or worsening symptoms to their healthcare provider promptly.


Diagnosis of Multiple Myeloma Kidney Hematoma


Diagnosing a kidney hematoma requires a multifaceted approach, combining blood tests, imaging studies, and sometimes biopsy:


  • Blood Tests: Blood tests, including a complete blood count (CBC) and serum creatinine, help evaluate kidney function, detect anemia, and assess the overall health of multiple myeloma patients.


  • Urine Tests: Urine analysis can reveal the presence of abnormal proteins and blood, indicators of kidney damage and potential hematoma.


  • Imaging Studies: Ultrasounds, CT scans, and MRIs provide a clear view of the kidneys, allowing doctors to detect hematomas and assess their size and location.


  • Kidney Biopsy: In some cases, a kidney biopsy is performed to gather more information. However, this carries a slight risk of worsening a hematoma, so it’s typically used only when essential for diagnosis.


Treatment Options for Multiple Myeloma Kidney Hematomas


Addressing a kidney hematoma in multiple myeloma usually requires a dual approach: you need to manage both the hematoma itself and the underlying multiple myeloma. Here are the main treatment strategies most patients deploy:


1. Managing Multiple Myeloma

  • Chemotherapy and Targeted Therapy: Treating the multiple myeloma helps reduce protein production and may slow kidney damage. Some common treatments include chemotherapy agents like bortezomib and lenalidomide, which specifically target cancerous plasma cells.


  • Stem Cell Transplant: For eligible patients, a stem cell transplant may provide a longer-term treatment solution, potentially reducing the rate of protein production and relieving stress on the kidneys.


2. Hematoma-Specific Treatments

  • Conservative Management: Small hematomas may resolve on their own with rest, hydration, and avoiding any strain on the kidneys. In these cases, close monitoring with follow-up imaging is essential.


  • Surgical Intervention: Large or worsening hematomas may require surgical drainage or other interventions to prevent further kidney damage.


3. Supportive Care and Complication Prevention

  • Hydration: Ensuring adequate hydration can support kidney function and help dilute harmful proteins, reducing kidney stress.


  • Avoiding Nephrotoxic Medications: Certain medications, including some painkillers, can worsen kidney function and increase bleeding risk, so careful medication management is essential.


  • Preventing Bleeding: Addressing bleeding risks with transfusions, if needed, or medications to boost platelet counts can reduce the likelihood of hematoma formation.


Prognosis and Outlook for Multiple Myeloma Patients with Kidney Hematomas


The prognosis for patients with multiple myeloma kidney hematomas depends on multiple factors, including the size and location of the hematoma, the stage of multiple myeloma, and the patient’s overall kidney function. Early intervention, both for multiple myeloma and kidney hematomas, can improve outcomes and may slow the progression of kidney impairment. According to a study published in the Journal of Clinical Oncology, patients with managed kidney complications often experience a better quality of life and improved survival rates compared to those without regular monitoring.


Conclusion


Multiple myeloma kidney hematomas represent a challenging complication that underscores the complexity of managing multiple myeloma. While kidney damage is a common issue for patients with this disease, hematomas require particular attention due to their potential for serious complications. Recognizing the signs, understanding the diagnostic steps, and being aware of treatment options can help patients and caregivers stay proactive in managing both multiple myeloma and kidney health.


If you or a loved one has multiple myeloma, it’s vital to work closely with your healthcare team to monitor kidney function and address any complications early. For additional support and insights from others facing similar challenges, consider joining Patient Connect at Polygon Health, where multiple myeloma patients share experiences and access resources to navigate their journey.

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