Nephrolog

Diabetic retinopathy is present in more than 95% of individuals with diabetic
nephropathy.. A urinalysis should be performed on every patient with systemic lupus erythematosus
(SLE) at each visit, and abnormalities in the urine should be confirmed and evaluated by
a nephrologist. Immunologic serology for SLE and serum chemistries are also useful to
determine whether lupus nephritis is present.. Urinalysis, although important, may be misleading because the increased urinary excretion
of light chains associated with myeloma is not detected by testing for albumin
(e.g., Albustix) but only for total protein (e.g., sulfosalicylic acid test) or by specific
urine electrophoresis and immunofixation.. Myeloma cast nephropathy is a medical emergency and requires immediate diagnosis
and early institution of therapy to prevent irreversible renal failure.. Dexamethasone, 20 mg bid, which induces apoptosis of plasma cells, can be immediately
commenced to rapidly reduce the serum light-chain load while additional chemotherapy
agents are considered.. Kidney injury is principally related to the light-chain component of myeloma because,
unlike immunoglobulins, light chains are freely filtered at the glomerulus and reabsorbed
in the proximal tubule.. The measurement of serum free light-chain (FLC) by nephelometry is rapid (hours); is
more sensitive (1–3 mg/L); and, along with a serum panel of protein electrophoresis
(SPE) (to determine the presence or a whole immunoglobulin component), will diagnose
the majority of patients with myeloma, amyloidosis, and other monoclonal Ig deposition diseases.