[Music] what kidney problems are associated with myeloma kidney problems are one of the hallmarks of active multiple myeloma probably the main way that myeloma hurts the kidney is through the production of the light chain antibody fragments that many patients have detectable in their blood which have the ability to pass through the kidneys and into the urine and as they do so they can interfere with normal kidney function clog up the your in collecting systems of the kidney and predispose the kidneys to other forms of injury so the most important mechanism for kidney injury is actually direct injury by the light chains produced by the myeloma cells and the most important way to avoid that or to prevent it or to treat it when it happens is to treat the myeloma with chemotherapy and lower the light chain levels for some patients who present with very abnormal kidney function especially early on in the course of the disease we sometimes use treatments to directly remove the light chains from the blood using plasmapheresis or hemodialysis with a special hemodialysis filter to try to aid the chemotherapy and quickly improving kidney function in addition there are a few other ways that kidneys can get hurt in patients with myeloma probably the most important one is dehydration dehydration can happen in myeloma sometimes when the calcium level goes very high in the blood which is a direct result of the myeloma progressing and causing problems but also sometimes in patients who are feeling sick and not drinking enough fluids so one of the most important things that patients with myeloma can do to help protect their kidneys is to stay well hydrated and that means drinking lots of fluid during the daytime so that patients are regularly urinating over the course of the day although I do like to tell my patients that it's not necessary to drink so much fluids that they're up all night going to the bathroom and then the last thing that we think hurts the kidneys in myeloma are some of the treatments that we use for some of the symptoms or to help diagnose problems related to myeloma and so pain medicines that can hurt the kid primarily include the non-steroidal anti-inflammatory drugs like naproxen or Aleve or ibuprofen which has the brand names Advil or motrin those medicines do have some ability to hurt the kidneys and so in general we tell our patients to try to avoid them in general the best pain medicines to use are acetaminophen or Tylenol or the narcotic pain medicines like oxycodone morphine hydromorphone and fentanyl because those don't have any chance of hurting the kidneys and then some of the intravenous contrast dyes that we use for radiology tests to detect problems related to myeloma or other problems can also hurt the kidneys that's not true of all of the contrast materials that we use it's really related to the iodine containing contrast that we use for x-ray tests so that for instance contrast that we use for MRI scans or for PET scans in general do not have any risk of hurting the kidneys it's often difficult to keep all of those straight so I usually tell my patients that for any test where their physician orders for them that includes an injection of intravenous contrast it's worth asking if that's the type of contrast that has the ability to hurt the kidneys and if it is whether their risk of kidney injury has been carefully thought about because while it may sometimes be the right answer to go ahead and use that contrast it's always worth taking a pause to think about whether it's really necessary and whether it's worth the risks the kidneys