Step I Why should myeloma patients drink lots?

[mhco]

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Hi,

Just wondering what the physiology behind giving lots of fluid to myeloma patients is.

I know myeloma can cause hypercalcemia, and tubero-interstitial nephritis.

But what effect does giving them lots of fluid have? Does it improve renal function? Dilute the light chains damaging the kidneys?

I know you're meant to just give a normal level of fluids to CKD patients (http://cjasn.asnjournals.org/content/1/2/344.full), so what is the logic in myeloma.

Thanks in advance

 

[tasar1898]

As far as I remember , one MOD in myeloma kidney is this light chain (AL maybe? ) clogs up the tubules and 1) creates a post-renal failure like disease with pressure atrophy of the glomeruli , just like in ethyl alcohol poisoning , 2) creates a toxic ATN-like disease . So giving tons of fluid will ''wash'' out this ''junk'' and give your glomeruli + tubules some breathing room

In CKD , the kidney is already ''finished'' so there is no point in overloading your ICF/ECF space with extra fluid that the kidney can't really process. So I think it makes sense that even in MM , if your kidney reaches ESRD criteria , extra fluids is no longer the recommendation

 

[Jabbed]

Hyperuricemia from tumor lysis syndrome. Load 'em up with fluids and XO inhibitors to prevent urate stone formation.