scholarly journals Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains

2008 ◽  
Vol 73 (11) ◽  
pp. 1282-1288 ◽  
Author(s):  
N. Leung ◽  
M.A. Gertz ◽  
S.R. Zeldenrust ◽  
S.V. Rajkumar ◽  
A. Dispenzieri ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

scholarly journals Extracorporeal light chains removal – What role does this play in 2020?

2021 ◽  
Vol 34 (4) ◽  
Author(s):  
Inês Coelho ◽  
◽  
Hugo Ferreira ◽  
Teresa Chuva ◽  
Ana Paiva ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Injury ◽  
Rapid Decrease ◽  
Light Chains ◽  
Free Light Chains ◽  
Monoclonal Immunoglobulin ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Cell Clones ◽  
Serum Free Light Chains

Multiple Myeloma (MM) is characterized by a neoplastic proliferation of plasma cell clones producing monoclonal immunoglobulin. Manifestations of the disease are heterogenous and include dialysis­‑requiring acute kidney injury (AKI) caused mainly by cast nephropathy (CN). It is known that early and rapid decrease in serum free light chains (sFLC) levels is particularly important for renal recovery, which has led to a renewed interest in extracorporeal methods of removal of sFLC. In this review we will discuss the management of light chain CN focusing on extracorporeal light chains removal modalities and their indication.

A Review of Multiple Myeloma Patients on Dialysis Treated with High Cutoff Hemodialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5002-5002
Author(s):  
Tiina Podymow ◽  
Ahsan Alam ◽  
Murray Vasilevsky ◽  
Roch Beauchemin ◽  
Chaim Shustik ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Function ◽  
Kidney Failure ◽  
Conflicts Of Interest ◽  
Controlled Trial ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

Abstract Abstract 5002 Background: Kidney failure is a major cause of morbidity in patients with Multiple Myeloma (MM). While up to half of MM patients can be shown to have renal impairment, 10% will become dialysis dependent. The main mechanism of kidney failure is cast nephropathy, which is linked to high amounts of circulating free light chains. A proposed strategy to prevent this outcome is the use of extended high cutoff (HCO) dialysis. An ongoing randomized controlled trial is testing the Gambro HCO1100 filter. Here we report the use of another dialyzer (Bellco Phylther), which has a smaller pore size than the Gambro filter, but which may prove to be as effective and is less costly. Methods: We present three patients with symptomatic MM, elevated κ or λ serum free light chains (>500mg/L), biopsy confirmed cast nephropathy, and kidney failure (estimated GFR <15ml/min/1.73 m2) requiring dialysis. In all patients, dialysis consisted of 10 hemodiafiltration dialysis sessions in the first two weeks and three times a week thereafter using a high flux Bellco Phylther HF22SD dialyzer (Bellco, Modena, Italy). All patients received concurrent chemotherapy: bortezomib 1.3mg/m2 IV and dexamethasone 40mg po on days 1, 4, 8 and 11 of a 21 day cycle and liposomal doxorubicin at 30mg/m2 on day 4 of every cycle. Serum free light chains were determined pre- and immediately post-dialysis using a nephelometric immunoassay (FREELITE, The Binding Site, Birmingham UK). Results: We observed significant (>50%) and rapid reductions in sFLCs. These reductions were sustained at 3 months in all cases, likely because of effective anti-myeloma treatment. Two of the three patients had recovery of kidney function and remain dialysis-independent at least 6 months after cessation of dialysis. Interestingly, the only patient that did not recover kidney function was also found to have tubulointerstitial disease on renal biopsy in addition to cast nephropathy. Conclusions: The HCO Bellco Phylther dialyzer appears effective in the rapid reduction of sFLCs in light chain MM patients with cast nephropathy requiring dialysis and concurrent anti-myeloma drug therapy. While the numbers are small, our review suggests that patients with uncomplicated MM cast nephropathy may benefit from aggressive hemodiafiltration with this HCO membrane. This dialysis membrane and protocol are worth considering for further study in patients with MM cast nephropathy. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cast Nephropathy: Removal of Serum Free Light Chains by High Cut-off Hemodialysis

2015 ◽  
Vol 17 (2) ◽  
pp. S119
Author(s):  
H.L. Tang ◽  
H.M. Cheng ◽  
C.K.Y. Poon ◽  
L.Y. Wong ◽  
H.K.K. Lee ◽  
...  
Keyword(s):  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

scholarly journals Serum free light chains

Pathology ◽  
2021 ◽  
Vol 53 ◽  
pp. S4
Author(s):  
Karl W. Baumgart
Keyword(s):  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains
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