When a myeloma patient’s kidney creatinine levels increase, does this indicate a relapse?

What does it mean when creatinine levels increase?

Myeloma expert Dr. Brian G.M. Durie discusses the potential causes of increasing kidney waste product creatinine and what myeloma patients should do to address it.

The BOTTOM LINE:

Rising serum creatinine levels may not necessarily mean relapse. Talk carefully with your doctor and consult with a kidney specialist if needed.

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IMF TV Blog Category

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Transcript:

This week's “Ask Dr. Durie” comes from a patient with myeloma who has been in stable remission for over 10 years now. The question is: What about a rising serum creatinine? The serum creatinine had been low and normal, but the level of the creatinine has been increasing in the monthly blood tests. The question is: Does this mean that the myeloma is relapsing?   

Well, not so fast. I think that it’s important to check this out and figure out what is causing blood kidney testing, the serum creatinine level, to be going up. 

The important thing to know is that many things can make the serum creatinine go up. Sometimes you can just be short of water, dehydrated, and then the creatinine will go up. Sometimes if you have sugar diabetes, this can damage the kidneys and make the creatinine go up. If you've had ongoing high blood pressure, this can also impact the kidneys. 

There are several things to check including possible kidney infections. Now, regarding the myeloma, after many years it is possible that the myeloma can produce free-light chains and produce, what we call, Bence-Jones protein in the urine, and this light chain effect can damage the kidneys. So, it is important to check this out as well, to do a blood free light test for light chains, and to check a 24-hour protein to see if there’s an increase in protein in the urine. So, obviously, to check and make sure that if anything is going on related to myeloma. 

In terms of routine testing, it is important to check the blood counts, the myeloma protein level, the standard things that would be checked every month to make sure if there has been any change. And it may be if there’s a slight change, it’s worth repeating a bone marrow test, we don’t do that casually, but if there’s an important change, we might want to repeat a bone marrow test. We might also want to repeat X-rays or scans to make sure if there’s a new bone lesion or problem that has emerged. 

But BOTTOM LINE in this case is that many times a change in the kidney function, the serum creatinine test, is due to other things. And so, talk carefully to your doctor, who may request a consult with a kidney specialist just to check things out and see what’s going on. But check that out all first. Don’t just assume that this is a relapse of myeloma because many times it’s not, and you can fix the problem by treating diabetes, or treating kidney infection and continue.   


Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

 


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