A female client with suspected renal dysfunction is scheduled for excretory urography.
Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography.
Which history finding would call for the client to be well hydrated instead?
a- Cystic fibrosis.
b- Multiple myeloma.
c- Gout.
d- Myasthenia gravis.
Answer B.
Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don’t necessitate changes in client preparation for excretory urography.
Multiple myeloma of bones (also known as Kahler's disease, Kahler-Bozzolo's disease1, or, simply, myeloma) is a hematologic cancer (meaning that it develops from the cells of hematopoiesis, those -which are the origin of the blood cells, formed in the bone marrow).
The affected cells are plasma cells (which are end-differentiated B-lymphocytes), cells of the immune system producing antibodies (immunoglobulins) to fight infections and diseases. Myeloma is a disease characterized by the development in the skeleton of multiple osteolytic plasma cell tumors (plasmocytomas) secreting in most cases either a monoclonal immunoglobulin type G (52% of cases) or type A (21% of cases ), a light chain Kappa or Lambda (12%).
Epidemiology:
In France, the incidence is 4,000 cases per year. In the United States, 45,000 people live with myeloma with approximately 20,000 new cases each year. Its incidence tends to increase. It is more common among African-Americans and rarer in China. In Canada, approximately 2,000 people each year are diagnosed with multiple myeloma.
After diagnosis, incident-free survival is estimated at 5 months, total survival at 56 months5.
Myeloma is the second most common hematological disorder (10%) after non-Hodgkin's lymphoma. It accounts for about 1% of all cancers and 2% of all cancer deaths.
The average age of onset of myeloma is 65 to 70 years, but tends to decrease.
Myeloma affects a few more men than women.
The causes of multiple myeloma are poorly understood. Exposure to certain organochlorines (chlordecone used as a pesticide for example) seems to be one of the risk factors. For example, in Martinique, an InVS-controlled InVS cancer risk analysis found a "statistically significant over-incidence of multiple myeloma" in adult men residing in the area where chlordecone was most prevalent. used and would still be most present in soils (according to the BRGM). In addition, the gradient in myeloma incidence gradually increased from the areas believed to be the least polluted to those that are potentially most affected.
Circumstances of diagnosis:
Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography.
Which history finding would call for the client to be well hydrated instead?
a- Cystic fibrosis.
b- Multiple myeloma.
c- Gout.
d- Myasthenia gravis.
Answer B.
Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don’t necessitate changes in client preparation for excretory urography.
Multiple myeloma of bones (also known as Kahler's disease, Kahler-Bozzolo's disease1, or, simply, myeloma) is a hematologic cancer (meaning that it develops from the cells of hematopoiesis, those -which are the origin of the blood cells, formed in the bone marrow).
The affected cells are plasma cells (which are end-differentiated B-lymphocytes), cells of the immune system producing antibodies (immunoglobulins) to fight infections and diseases. Myeloma is a disease characterized by the development in the skeleton of multiple osteolytic plasma cell tumors (plasmocytomas) secreting in most cases either a monoclonal immunoglobulin type G (52% of cases) or type A (21% of cases ), a light chain Kappa or Lambda (12%).
Epidemiology:
In France, the incidence is 4,000 cases per year. In the United States, 45,000 people live with myeloma with approximately 20,000 new cases each year. Its incidence tends to increase. It is more common among African-Americans and rarer in China. In Canada, approximately 2,000 people each year are diagnosed with multiple myeloma.
After diagnosis, incident-free survival is estimated at 5 months, total survival at 56 months5.
Myeloma is the second most common hematological disorder (10%) after non-Hodgkin's lymphoma. It accounts for about 1% of all cancers and 2% of all cancer deaths.
The average age of onset of myeloma is 65 to 70 years, but tends to decrease.
Myeloma affects a few more men than women.
The causes of multiple myeloma are poorly understood. Exposure to certain organochlorines (chlordecone used as a pesticide for example) seems to be one of the risk factors. For example, in Martinique, an InVS-controlled InVS cancer risk analysis found a "statistically significant over-incidence of multiple myeloma" in adult men residing in the area where chlordecone was most prevalent. used and would still be most present in soils (according to the BRGM). In addition, the gradient in myeloma incidence gradually increased from the areas believed to be the least polluted to those that are potentially most affected.
Circumstances of diagnosis:
Multiple myeloma is often detected incidentally during a routine blood test.
The most common symptoms guiding this biological discovery are:
- bone pain or pathological fractures (spontaneous or after too little stress) 7,8;
- asthenia, which may be related to anemia, hypercalcemia or renal failure;
- tingling in the extremities and neuropathic pain.
Diagnostic:
Biological diagnosis:
The main consequence of myeloma is the presence of a very large amount of immunoglobulins in the blood. These immunoglobulins are proteins, which are manifested by:
- the elevation of the sedimentation rate;
- hyperprotidemia;
a peak in the gamma-globulin zone at electrophoresis of serum proteins in full-chain forms. The immunofixation makes it possible to prove the monoclonal character of the peak (that is to say deriving from the same tumor cell clone). In light chain forms, hypogammaglobulinemia is observed, the amount of light chains being almost never sufficient to produce a visible monoclonal peak.
Hypercalcemia, which is common, is linked to bone destruction.
There is also an excess of protein in the urine; this proteinuria consists of monoclonal immunoglobulin light chains, also called Bence-Jones protein. Immunoelectrophoresis or immunofixation of urinary proteins determines the type of chain, kappa or lambda. This peak is detected in beta-globulins.
Benign monoclonal gammopathy does not include anemia, bone lesions or visceral complications. As its name suggests, it does not have the same character of gravity as myeloma and requires only simple monitoring.
Other exams:
A solitary lytic plasmocytoma located in the lower third of the femur.
Multiple osteolysis and pathological fracture of the ulna.
The myelogram studies the bone marrow cells, taken by puncture, in search of an excess of plasma cells. In myeloma, the marrow is infiltrated by plasma cells, which usually have many morphological abnormalities and are frequently in mitosis.
Radiographs of the skeleton very frequently show bone lesions such as osteolysis.
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