Intravenous Pyelography in Multiple Myeloma

Isolated reports of acute renal failure associated with intravenous pyelography (IVP) in patients with multiple myeloma have appeared in the literature (1–5). Some authors have implied and others have stated that this study is con-traindicated in the presence of such a diagnosis. It has been well established clinically that renal failure is common in myeloma, and pathologic changes have been recognized for a long period. We have reviewed our experience with multiple myeloma in an attempt to ascertain the risk involved in performing intravenous pyelography in these patients. The general subject of renal impairment will also be discussed since this aspect of multiple myeloma is pertinent to the problem and has not been specifically taken up in the radiological literature. Case Material Charts dating back to 1949 of 88 patients with a tissue-proved diagnosis of multiple myeloma were reviewed; all were males in keeping with our hospital population (VA Hospital, Minneapolis, Minn.). Diatrizoate sodium (Hy-paque) was employed as the contrast agent in almost all of the studies. Patients who are still alive or who have been lost to follow-up were observed for 4–288 weeks (mean 92.8). The 64 patients known to be dead were followed for 1–360 weeks (mean 58.9). Postmortem examinations were performed in 58 patients. Particular attention in the chart review was paid to the blood urea nitrogen, serum electrophoresis, urine electrophoresis, serum calciums, and whether or not intravenous pyelography had been performed. Other evidence of the renal status was sought, but the blood-urea-nitrogen determination proved to be the only test performed repeatedly on most of the patients. An attempt was made to ascertain the incidence of azotemia and its course, especially as it might be related to previous intravenous pyelography. Special attention was directed toward instances of rapidly progressing azotemia. Our search of the charts disclosed 52 intravenous pyelographic examinations in 40 patients. The method of electro-phoretic study and the definition of a Bence-Jones protein have been given in detail in a previous report from this hospital (6). Results Findings on Intravenous Pyelography: Forty-five intravenous pyelograms in 33 patients showed normal function. The highest recorded blood urea nitrogen near the time of the procedure was 34 mg per 100 cc. Seven pyelograms in 7 patients indicated poor function by either faint or no visualization of the collecting system; Table I lists the pertinent findings in this group. The blood-urea-nitrogen determinations listed were obtained within two weeks of urography. All cases with poor excretion of contrast material showed either amyloidosis or Bence-Jones proteinuria except for one with normal serum proteins, in whom no urine elec-trophoretic study was performed.