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What is Multiple Myeloma?
Multiple myeloma is a type of blood cancer. It affects plasma cells that produce antibodies to fight infections and diseases.
Healthy plasma cells are found inside bones in the bone marrow. Abnormal plasma cells can grow out of control and form tumors in the bones.
A single plasma cell tumor is known as an isolated plasmacytoma. A person who has more than one plasmacytoma has multiple myeloma.
The antibodies made by plasma cells are special proteins that circulate throughout the body in the blood stream. Multiple myeloma causes affected plasma cells to create large numbers of abnormal proteins that cannot be used by the body.
Multiple myeloma can also damage bone tissue and cause it to break down or dissolve. Hypercalcemia is the condition that results when dissolved bone results in abnormally high amounts of calcium in the blood.
How Does Multiple Myeloma Affect the Kidneys?
Kidney failure is a common complication of multiple myeloma that affects approximately 20 percent of patients.
The kidneys are organs in the abdomen that act as filters to clean waste products out of the blood stream. This waste is passed out of the body as urine.
Multiple myeloma can damage the kidneys’ ability to filter waste.
Kidney failure results when the kidneys are no longer able to function and they shut down. Kidney failure must be treated with dialysis in which machines take over the work of the kidneys to remove waste from the body.
If multiple myeloma results in excess calcium in the blood, the kidneys can be damaged due to overwork as they try to remove the extra calcium. This can cause permanent kidney damage.
Multiple myeloma can also damage the tubules inside the kidneys that allow blood to flow through the kidney to be filtered. Abnormal proteins created by cancerous plasma cells travel through the blood to the kidneys.
Normal proteins are small enough to pass through the tubules without causing damage. But chains of abnormal proteins can sometimes link up with other proteins in the kidney that are a normal part of urine.
Entire communities of sugar-farm laborers in Central America are being crippled by a sometimes deadly kidney malady — and nobody knows why. But some think the herbicide glyphosate, sold by Monsanto under the name Roundup, may be connected to the epidemic.
NPR reports on the rash of illnesses:
The first reports of this disease date back at least 20 years. At first the clusters of men dying of kidney failure was dismissed as a fluke. Then it was written off as diabetes or some other underlying health problem that hadn’t been correctly diagnosed.
Despite years of research all over the world, scientists still can’t definitively pinpoint the cause.
“We don’t know. That’s the unfortunate part, and we do desperately need to find some answers,” says Reina Turcios-Ruiz, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention’s office in Guatemala City.
This form of kidney failure, known as insuficiencia renal cronica in Spanish (or chronic kidney disease of unknown origin in English), is now found from southern Mexico to Panama, Turcios-Ruiz says. But it occurs only along the Pacific coast.
The disease is killing relatively young men, sometimes while they’re still in their early 20s. Researchers at Boston University have attributed about 20,000 deaths to this form of kidney failure over the past two decades in Central America.
Chronic kidney disease has also shown up in rice-farming communities of Sri Lanka, leading the country’s government to restrict the use of Roundup and similar herbicides earlier this year.
Shortly before the Sri Lankan restrictions were imposed, a study published in the International Journal of Environmental Research and Public Health hypothesized a link between glyphosate and the kidney disease in areas with hard ground water that contains certain metals. “Although glyphosate alone does not cause an epidemic of chronic kidney disease, it seems to have acquired the ability to destroy the renal tissues of thousands of farmers when it forms complexes with a localized geo environmental factor (hardness) and nephrotoxic metals,” the researchers concluded.
The NPR reporter interviewed a victim of the mystery disease who is convinced that agricultural chemicals are to blame. “It was the chemicals, the chemicals at the plantation,” sickened Nicaragua sugar worker Manuel Antonio Tejarino said. “I feel like I’m burning. My blood pressure goes down. I get dizzy. Someone has to help me walk. If I’m alone I’ll fall down.”
A heretofore inexplicable fatal, chronic kidney disease that has affected poor farming regions around the globe may be linked to the use of biochemical giant Monsanto’s Roundup herbicide in areas with hard water, a new study has found.
The new study was published in the International Journal of Environmental Research and Public Health.
Researchers suggest that Roundup, or glyphosate, becomes highly toxic to the kidney once mixed with “hard” water or metals like arsenic and cadmium that often exist naturally in the soil or are added via fertilizer. Hard water contains metals like calcium, magnesium, strontium, and iron, among others. On its own, glyphosate is toxic, but not detrimental enough to eradicate kidney tissue.
The glyphosate molecule was patented as a herbicide by Monsanto in the early 1970s. The company soon brought glyphosate to market under the name “Roundup,” which is now the most commonly used herbicide in the world.
The hypothesis helps explain a global rash of the mysterious, fatal Chronic Kidney Disease of Unknown etiology (CKDu) that has been found in rice paddy regions of northern Sri Lanka, for example, or in El Salvador, where CKDu is the second leading cause of death among males.
Furthermore, the study’s findings explain many observations associated with the disease, including the linkage between the consumption of hard water and CKDu, as 96 percent of patients have been found to have consumed “hard or very hard water for at least five years, from wells that receive their supply from shallow regolith aquifers.”
The CKDu was discovered in rice paddy farms in northern Sri Lanka around 20 years ago. The condition has spread quickly since then and now affects 15 percent of working age people in the region, or a total of 400,000 patients, the study says. At least 20,000 have died from CKDu there.
In 2009, the Sri Lankan Ministry of Health introduced criteria for CKDu. Basically, the Ministry found that CKDu did not share common risk factors as chronic kidney disease, such as diabetes, high blood pressure and glomerular nephritis, or inflammation of the kidney.
Based on geographical and socioeconomical factors associated with CKDu, it was assumed that environmental and occupational variables would offer clues to the disease’s origins – or in this case, it came from chemicals.
The new study noted that even the World Health Organization had found that CKDu is caused by exposure to arsenic, cadmium, and pesticides, in addition to hard water consumption, low water intake, and exposure to high temperatures. Yet why that certain area of Sri Lanka and why the disease didn’t show prior to the mid-1990s was left unanswered.
Researchers point out that political changes in Sri Lanka in the late 1970s led to the introduction of agrochemicals, especially in rice farming. They believe that 12 to 15 years of exposure to “low concentration kidney-damaging compounds” along with their accumulation in the body led to the appearance of CKDu in the mid-90s.
The incriminating agent, or Compound “X,” must have certain characteristics, researchers deduced. The compound, they hypothesized, must be: made of chemicals newly introduced in the last 20 to 30 years; capable of forming stable complexes with hard water; capable of retaining nephrotoxic metals and delivering them to the kidney; capable of multiple routes of exposure, such as ingestion, through skin or respiratory absorption, among other criteria.
These factors pointed to glyphosate, used in abundance in Sri Lanka. In the study, researchers noted that earlier studies had shown that typical glyphosate half-life of around 47 days in soil can increase up to 22 years after forming hard to biodegrade “strong complexes with metal ions.”
Scientists have derived three ways of exposure to glyphosate-metal complexes (GMCs): consumption of contaminated hard water, food, or the complex could be formed directly within circulation with glyphosate coming from dermal/respiratory route and metals from water and foods.
Rice farmers, for example, are at high risk of exposure to GMCs through skin absorption, inhalation, or tainted drinking water. GMCs seem to evade the normal liver’s detoxification process, thus damaging kidneys, the study found.
The study also suggests that glyphosate could be linked to similar epidemics of kidney disease of unknown origin in El Salvador, Nicaragua, Costa Rica, and India.
Recent investigations by the Center for Public Integrity found that, in the last five years, CKDu is responsible for more deaths in El Salvador and Nicaragua than diabetes, AIDS, and leukemia combined.
Multiple myeloma (MM) is a clonal B-cell disease of slowly proliferating plasma cells, accompanied by monoclonal protein production and lytic bone lesions. Up to 50 per cent of newly diagnosed patients have a decrease in creatine clearance and 20 per cent of Multiple Myeloma patients Kidney failure occurs as a consequence of elevated calcium levels in the blood or when the kidneys are overloaded with protein.
Normally, the kidneys remove wastes, extra fluids, and minerals from the blood. But when they stop functioning, harmful wastes build up and this can cause other complications such as high blood pressure. In addition, the disease can cause too much calcium to leave your bones and head into your bloodstream, where it can put a strain on your kidneys.
When kidney failure is irreversible, patients undergo a procedure known as dialysis to help their bodies filter blood. Dialysis removes the extra fluid and waste from the blood, and it can prolong the overall survival for multiple myeloma patients.
The incidence of renal failure certainly rises as the tumor load increases, but it is the underlying tumor burden that ultimately determines survival. Therefore, treatment of myeloma to achieve reduction might also reduce the occurrence of kidney failure.
The most common test used as a follow-up to abnormal routine tests and to help diagnose the disease include Protein and Immunofixation Electrophoresis. This test is used to diagnose and monitor multiple myeloma. Protein electrophoresis separates the proteins in a blood or urine sample into several groups based on their electrical charge and size. In most patients with multiple myeloma, large amounts of an abnormal immunoglobulin protein (M-protein) will show up as a large peak on the electrophoresis graph.
Usually, both a blood and a urine sample will be tested during the diagnosis of multiple myeloma because some proteins, such as the Bence Jones proteins (free light chains), may not show up in significant quantities in blood samples, while those with only intact immunoglobulins may not have the abnormal protein in urine.
Bence Jones protein (free light chains) can be detected in the urine of some patients with multiple myeloma. Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.
—Dr Bharat Vaswani, Yashoda Hospital