Still in Remission! But Kidney Problems

We went to Denver today, to the Colorado Blood Cancer Institute, to see Doug's myeloma specialist. He said Doug "is in pretty good shape". The bone marrow biopsy came back clean - excellent! He did say that is not a guarantee that the marrow does not contain cancer cells, since only a small area is biopsied. But it is a good indicator. He said the rise in light chains is "non-specific" and inconclusive. So he considers Doug to be still in remission. Yea! Those are welcome words indeed. He wants Doug to resume the Revlimid, 5 mg every other day. No dexamethasone. This is the maintenance regime he's been on for a while now. Doug will need a CBC every few weeks to watch the ANC (absolute white cell count).

But the report from the nephrologist shows a kidney problem: Doug's kidneys are leaking protein, and he has low level of albumin in the blood. He has very minimal swelling and only in his legs. Plasma cell problems can irritate the kidneys and make them leak protein. The nephrologist calls it "nephrotic syndrome".

from WebMD:

What is nephrotic syndrome?

Nephrotic syndrome is a sign that your kidneys are not working right. You have nephrotic syndrome if you have high levels of protein in your urine and low levels of protein in the blood.

Nephrotic syndrome is not a disease. It is a warning that something is damaging your kidneys. Without treatment, that problem could cause kidney failure.

What causes nephrotic syndrome?

There are tiny blood vessels in the kidneys  that filter waste and extra water from the blood. When these filters are damaged, you get nephrotic syndrome. Protein helps move water from the tissues into the blood. Healthy kidneys keep the right amount of protein in the blood. Damaged kidneys let protein slip from the blood into the urine. Without enough protein in the blood, fluid builds up in the tissues. 

The myeloma specialist expects the kidney problem is due to one of two causes: Light Chain Deposition Disease, or Amyloidosis. In LCDD (usually kappa) light chains lodge in a certain part of the kidney, causing damage. Doug's MM is lambda, not kappa. 

In Amyloidosis (usually lambda), the light chains turn into a stiff protein called amyloid that is toxic to the kidneys. This would not be good, and might need different treatment. 

Doug needs further testing - first a 24 hour urine collection. Depending on the results of that, he might need a kidney biopsy. We have to wait and see. 

For now we are basking in the good news that Doug is still in remission. We'll handle the kidney problem as test results come back. 

"Give your entire attention to what God is doing right now, and don't get worked up about what may or may not happen tomorrow. God will help you deal with whatever hard things come up when the time comes."      Matthew 6:34       The Message