The patient has multiple myeloma. Can they get IV contrast material?

The patient has multiple myeloma. Can they get IV contrast material?

As long as the patient has normal renal function and is well hydrated there is no added risk in this population. The risk occurs when patients are dehydrated and in those patients with myeloma associated nephropathy. The ACR Manual on Contrast Media Version 6.0 states that “Paraproteinemias, particulary multiple myeloma are known to predispose patients to irreversible renal failure after contrast administration due to tubular protein precipitation and aggregation. This hazard may be prevented with good hydration; such ptients should not have extensive enemas before procedures nor should they be restricted from drinking. Instead oral and if necessary intravenous hydration should be encouraged.

"Multiple Myeloma was originally thought to be a significant risk factor for developing contrast nephropathy. Subsequently, the risk has been shown not to be related to myeloma per se but rather to the presence of associated dehydration and hypercalcemia"

"The incidence of contrast nephropathy in myeloma patients is approximately 0.6-1.25% compared to a risk of 0.15% in the general public"

References:

• IV Contrast Administration for CT: A Survey of Practices for the Screening and Prevention of Contrast Nephropathy
  Elicker BM et al. 
  AJR 2006; 186:1651-1658
• McCarthy CS, Becker JA  
  Multiple Myeloma and contrast media. Radiology 1992;183 : 519-521
  
• DeFronzo RA, Humphrey RL, Wright JR, Cooke CR. 
  Acute renal failure in multiple myeloma. Medicine 1975;54 : 209-223

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"The incidence of CIN in patients with multiple myeloma with a normal creatinine level is low and correlates with _2-microglobulin levels. The administration of contrast agent in this patient population is safe but should be based on the potential benefits of the examination and the expected low risk of developing CIN."

Incidence of Contrast-Induced Nephropathy in Patients With Multiple Myeloma Undergoing Contrast-Enhanced CT
Pahade JK et al.
AJR 2011; 196:1094-1101

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"In patients with myeloma, renal failure is the second most common cause of death after infection. The development of renal failure may affect 20-40% of patients with newly diagnosed myeloma, with 52-69% of patents having normal renal function at diagnosis."

Incidence of Contrast-Induced Nephropathy in Patients With Multiple Myeloma Undergoing Contrast-Enhanced CT
Pahade JK et al.
AJR 2011; 196:1094-1101

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Renal Failure in Multiple Myeloma Patients: Etiology

Toxic effects of excreted monoclonal light chains is primary cause. This can be exacerbated by;

• Hypercalcemia
• Dehydration
• Infection
• Bence Jones proteinuria
• Nephrotoxic drugs