MYELOMA CAST NEPHROPATHY AND PLASMAPHERESIS
The horizontal blue bar shows the day-by-day urine volume. Performing an early renal biopsy if myeloma cast nephropathy and AKI are concurrently present may lead to improved renal recovery outcomes. Five months before admission, her serum calcium and creatinine levels had increased to It is our opinion, that kappa and lambda myeloma cast nephropathy be treated similarly from the plasma exchange perspective. Early diagnosis and treatment affect kidney function and even patient survival. Support Center Support Center. Hypercalcemia, renal failure, anemia, and bone lesions CRAB are the four distinctive features of multiple myeloma. Plasmapheresis is theoretically attractive as a means of rapidly lowering serum FLC burden in the hope of reducing nephrotoxicity in patients with multiple myeloma.
Abstract Myeloma cast nephropathy is a major complication of multiple myeloma. Learn how your comment data is processed. However, it is not currently in clinical use. Normally, FLCs pass easily through the glomerular capillary and are reabsorbed at the proximal tubulus by the cubilin—megalin complex, located at the proximal apical membrane. Five months before admission, her serum calcium and creatinine levels had increased to Her serum total protein concentration was Other recent evidence showed that bortezomib-based chemotherapy with PE resulted in a better outcome, and the authors of these studies emphasized the importance of early induction therapy.
There was a problem providing the content you requested
Other recent evidence showed that bortezomib-based chemotherapy with PE resulted in a better outcome, and the authors of these studies emphasized the importance of early induction therapy. The purpose of this article is to review the rationale for using plasmapheresis for this indication and then provide a discussion of the evidence regarding its use. Her general fatigue and appetite loss increased gradually, and she was admitted to our hospital. Mechanism and prevention of acute kidney injury from cast nephropathy in a rodent model.
Myeloma cast nephropathy caused by numerous monoclonal free light chains FLCs is a major phenotype involving the kidney [ 4 ]. Recent data showed that survival was better in patients receiving early induction therapy who had recovered kidney function casg in nephgopathy who had not recovered kidney anv [ 14 ].
Ten days after admission, bortezomib-based chemotherapy with selective PE achieved rapid and thorough free light-chain FLC reduction; within a month, her kidney nephrooathy had been recovered creatinine level, 1. This case was compatible with myeloma cast nephropathy; however, the glomerular lesions had several differential diagnoses, including amyloid light-chain AL amyloidosis, monoclonal immunoglobulin deposition disease MIDDproliferative glomerulonephritis with monoclonal immunoglobulin deposition PGNMIDand diabetic nephropathy.
Pathological findings showed three distinct features: Subsequent kidney biopsy showed the clear presence of myeloma cast nephropathy, but glomerular nodular lesions had several differential diagnoses. Recent evidence now indicates that plasmapneresis early and sustained reduction in circulating free light chains FLCs is associated with improved renal recovery in patients with myeloma kidney. In addition, her previous serum creatinine was 0.
Plasmapheresis in cast nephropathy: yes or no?
Renal improvement in myeloma with bortezomib plus plasma exchange. In addition, Hutchison et al.
However, the role of plasmapheresis in improving renal prognosis and patient survival remains to be demonstrated. Author nepjropathy Article notes Copyright and License information Disclaimer.

Therefore, the principles of the treatment of myeloma cast nephropathy are the elimination of FLCs and restriction of FLC production using chemotherapy [ 12 ]. She had a year history znd type II diabetes mellitus, hypertension, and hyperuricemia.
Multiple myeloma is a cancer of plasma cells that produces monoclonal immunoglobulin and invades and destroys adjacent bone tissue [ 12 ].

Moreover, detailed analysis by electron microscopy showed no evidence of dense deposition, but very thick glomerular membrane, suggesting diabetic nephropathy. Introduction Multiple myeloma is a cancer of plasma cells that produces monoclonal immunoglobulin and invades and destroys adjacent bone tissue [ 12 ].
Among these, myeloma cast nephropathy is a major phenotype [ 1 ]. To our knowledge there is not a difference between treatment with plasma exchange in lambda vs. Left panel shows mononuclear inflammatory cell infiltration in the tubulointerstitial area and PAS-negative cast formation in the distal tubular lumen, partly surrounded by mononuclear inflammatory cells.
SCM Plasmapheresis and Cast Nephropathy: Does It Help? – AJKD Blog
Compliance with ethical standards Conflict of interest All the authors have declared no competing interest. Its estimated incidence plasmapheresix 2—3 patients per thousand people in Japan. Interestingly, Hutchison et al. Human rights All procedures performed in studies involving this participant was in accordance with the ethical standards of the institutional and national research committee at which the studies were conducted and with the Helsinki declaration and its later amendments or comparable ethical standards.
Published online Aug However, patients with renal failure who do not recover independent renal function continue to have very poor prognosis. Her serum total protein concentration was She had hypercalcemia s-cCa, We are presenting a case of plasmaphedesis year-old woman who initially presented with findings of pre-renal AKI that did not resolve after a few days of intravenous hydration.
Case report Plasmpaheresis year-old woman was admitted to our hospital for the evaluation of the chief complaints of general fatigue and appetite loss.
Plasmapheresis in cast nephropathy: yes or no?
Renal failure is a frequent complication of multiple myeloma and portends a poor nepphropathy. Abstract Myeloma cast nephropathy is a major complication of multiple myeloma. Learn how your comment data is processed. Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma. The clinical stage of multiple myeloma was IIIB according to the Durie Salmon classification [ 8 ], and its grade was III according to the international staging system [ 9 ].
A kidney biopsy was performed that had findings consistent with myeloma cast nephropathy in the setting of diffuse fibrosis myrloma tubular atrophy. Extracorporeal an of FLCs with plasmapheresis, or other techniques, can achieve rapid and sustained reduction in serum FLC concentration in patients with acute myeloma kidney.
Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases. Leave a Reply Cancel reply Enter your comment here
