scholarly journals Early use of PEPA dialyzer for light chains removal and for the recovery from myeloma cast nephropathy: A case report

2019 ◽  
Vol 23 (3) ◽  
pp. E97-E99 ◽  
Author(s):  
Gabriele Donati ◽  
Fulvia Zappulo ◽  
Anna Laura Croci Chiocchini ◽  
Giorgia Comai ◽  
Elena Zamagni ◽  
...  
Keyword(s):  
Case Report ◽  
Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy ◽  
Early Use

Primary Kidney Allograft Dysfunction Due to Myeloma-Cast Nephropathy: A Case Report

2007 ◽  
Vol 39 (5) ◽  
pp. 1683-1684 ◽  
Author(s):  
A. Perkowska-Ptasinska ◽  
M. Glyda ◽  
M. Paczkowski ◽  
M. Durlik
Keyword(s):  
Case Report ◽  
Kidney Allograft ◽  
Allograft Dysfunction ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy

P1114HA-130 HEMOPERFUSION CARTRIDGE IN THE TREATMENT OF CAST NEPHROPATHY IN A 58-YEAR-OLD MALE WITH MULTIPLE MYELOMA: A CASE REPORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Joanna Margarita Santos ◽  
Maria Kristina L Alolod
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Case Report ◽  
Light Chain ◽  
Free Light Chain ◽  
Light Chains ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Cast Nephropathy ◽  
History Of

Abstract Background and Aims Multiple myeloma is a plasma cell neoplasm that results in the production of monoclonal immunoglobulin. Renal failure is a common complication of multiple myeloma, occurring in approximately one-half of patients on initial presentation and is associated with increased mortality. Cast nephropathy in particular, is considered to be one of the major mechanisms of renal failure in multiple myeloma, and is characterized by precipitation of free light chains in the distal nephron, leading to intratubular obstruction, inflammation and fibrosis. Recent studies have demonstrated the use of extracorporeal methods such as plasmapheresis and high-cutoff membrane dialysis as an adjunctive therapy to chemotherapy in the management of cast nephropathy, however currently there are no existing guidelines in the use of extracorporeal therapies in the management of complications of multiple myeloma. Hemoperfusion is an extracorporeal treatment technique which utilizes adsorption in the removal of specific toxins. The HA 130 cartridge in particular has a resin pore size distribution of 500Da- 40 KDa and is able to remove molecules at 5-30kDa. In this case report we describe the use of HA 130 hemoperfusion cartridge in the treatment of cast nephropathy in Multiple Myeloma. Method A 58-year-old male, diabetic, non-hypertensive came in for 5-day history of generalized body weakness, associated with myalgia, lumbar pain and undocumented fever, with 1-day history of loose stools and vomiting. Upon admission blood tests done revealed anemia with a hemoglobin of 7.8g/dl, creatinine of 9.97mg/dL and potassium of 5.5mmol/L. He was diagnosed with acute renal failure and underwent hemodialysis on the second hospital day. On workup he had lytic bone lesions in the spine, pelvis and cranium on CT scan and x-ray. Serum Protein Electrophoresis (SPEP) and Serum Free Light Chain (sFLC) tests showed a monoclonal gammopathy. Serum beta 2 microglobulin was elevated at 12,618ng/ml. Free kappa and lambda light chains were also elevated at 19,250mg/L and 25.7mg/L, respectively. Bone marrow biopsy was done, with findings of markedly hypercellular marrow with 80% plasma cells confirming the diagnosis of Multiple Myeloma. Combined hemodialysis with hemoperfusion were done using HA 130 filter and hi flux dialyzer for 2.5 hours then hemodialysis for three times a week. Patient was also started on chemotherapy using Bortezomib with Dexamethasone for 2 cycles. Results Patient had a total of 14 sessions of combined hemoperfusion with hemodialysis. On repeat free kappa light chains decreased to 212.5mg/L. Patient was maintained on hemodialysis three times a week and was discharged after 55 hospital days. Outpatient hemodialysis was continued three times a week, and after 2 weeks, patient showed signs of renal recovery with a repeat creatinine of 2.1mg/dL. Four weeks after discharge, patient was independent of hemodialysis with a repeat creatinine of 1.3mg/dL. Conclusion This report highlights the use of hemoperfusion using HA 130 cartridge in combination with chemotherapy using Bortezomib in reducing free light chain levels in a 58-year-old male that developed renal failure secondary to cast nephropathy. Patient was able to achieve reduction in free light chain levels, improvement in renal function and eventually independence from hemodialysis four weeks after the last hemoperfusion treatment. Further studies using a randomized control trial on the use of hemoperfusion in directly reducing serum free light chain levels is recommended. The value of hemoperfusion on the rate of independence from hemodialysis, as well as survival rates among patients with renal failure secondary to multiple myeloma may also be worth investigating using larger studies.

scholarly journals Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Blanca Tarragón ◽  
Nan Ye ◽  
Martin Gallagher ◽  
Shaundeep Sen ◽  
Jose Maria Portolés ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multiple Myeloma ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy ◽  
All Cause Mortality

ABSTRACT Background Acute kidney injury (AKI) caused by cast nephropathy is associated with increased morbidity and mortality among patients with multiple myeloma (MM). High cut-off haemodialysis (HCO-HD) has proven to be effective in the removal of serum light chains but the effect on clinical outcomes, especially renal recovery, remains uncertain. Methods A systematic review and meta-analysis were performed examining all randomized controlled trials (RCTs) and observational studies (OBSs) assessing the effect of HCO-HD on clinical outcomes of patients with MM complicated by cast nephropathy–induced severe AKI. The primary outcome was all-cause mortality at the end of the study. The secondary outcomes included all-cause mortality at 12 months, HD independence and serum kappa and lambda light chain reduction. Pooled analysis was performed using random effects models. Results We identified five studies, comprising two RCTs and three retrospective cohort studies, including 276 patients with a mean follow-up of 18.7 months. The majority of the studies were of suboptimal quality and underpowered. Compared with patients treated with conventional HD, HCO-HD was not associated with a survival benefit at 12 months {five studies, 276 patients, relative risk [RR] 1.02 [95% confidence interval (CI) 0.76–1.35], I2 = 33.9%} or at the end of the studies at an average of 34 months [five studies, 276 patients, RR 1.32 (95% CI 0.71–2.45), I2 = 62.0%]. There was no difference in HD independence at 90 days [two trials, 78 patients, RR 2.23 (95% CI 1.09–4.55)], 6 months [two studies, 188 patients, RR 1.19 (95% CI 0.68–2.06)] or 12 months [two studies, 188 patients, RR 1.14 (95% CI 0.58–2.26)]. Patients receiving HCO dialysis, however, had a greater reduction in serum kappa [two studies, 188 patients, weighted mean difference (WMD) 46.7 (95% CI 38.6–54.7), I2 =  52.0%] and lambda [two studies, 188 patients, WMD 50.3 (95% CI 21.4–79.3), I2 = 95.1%] light chain levels. Conclusion Current evidence from RCTs and OBSs suggests HCO dialysis is able to reduce serum free light chains but makes no significant improvement in all-cause mortality and renal outcomes compared with conventional HD for patients with myeloma cast nephropathy. However, there is a trend towards better renal outcomes with the use of HCO dialysis. The lack of long-term data and the small sample sizes of the included studies limit this analysis. Therefore further large-scale RCTs with longer follow-up are needed to assess the effect of HCO dialysis on clinical outcomes in patients with myeloma cast nephropathy.

scholarly journals Effective Removal of κ-Free Light Chains with Hemodialysis Using Fresenius Ultraflux® EMiC®2 Dialyser in a Patient with Myeloma Cast Nephropathy, with Associated Cost Savings

2016 ◽  
Vol 42 (2) ◽  
pp. 158-159 ◽  
Author(s):  
Mathini Jayaballa ◽  
Bhadran Bose ◽  
Muralikrishna Gangadharan Komala ◽  
Eddy Ronald Fischer ◽  
John Taper ◽  
...  
Keyword(s):  
Cost Savings ◽  
Light Chains ◽  
Free Light Chains ◽  
Cast Nephropathy ◽  
Effective Removal ◽  
Myeloma Cast Nephropathy

MO670EXPANDED HEMODIALYSIS REDUCES THE CONCENTRATION OF FREE LIGHT CHAINS IN PATIENTS WITH ACUTE KIDNEY INJURY IN MYELOMA CAST NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Konstantin Vishnevskii ◽  
Olga Domashenko
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Average Concentration ◽  
High Flow ◽  
Low Flow ◽  
Light Chains ◽  
Free Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy

Abstract Background and Aims The myeloma cast nephropathy is largely associated with the production of intact immunoglobulin and free light chains (FLC) by a plasma cells monoclone. The use of high-flux hemodiafiltration (HDF) contributes to a decrease in the concentration of FLC. However, it is not always possible to achieve the required substitute volume with acute kidney injury (AKI) emergency treatment. An alternative to HDF could be the usage of membranes with a medium cut-off (expanded hemodialysis (HD), Expanded HD). The aim of this study was to compare the degree of reduction in FLC concentration using conventional HD, HDF and Expanded HD. Method The study includes patients with newly diagnosed multiple myeloma who presented indications for HD therapy start. Procedures were performed on a daily basis from the moment when indications for HD therapy were identified. The duration of the first three procedures was 2 hours. Consistently for each patient the first procedure was carried out using a standard low-flow filter, the second - using a high-flow dialyzer and HDF (substitute volume 9 liters for 2 hours), the third - using a Theranova 400 filter (Baxter, Germany). The concentrations of FLC (kappa and lambda) and albumin were determined every 30 minutes of each treatment. Chemotherapy was prescribed according to the local clinical recommendations in combination with the ongoing renal replacement therapy. Results The study included 7 patients with cast nephropathy, mean age 68±8 years. Average concentration before treatment: kappa FLC 876±727 μg/ml (norm 3.25-15.81 μg/ml), lambda FLK 84±112 μg/ml (norm 3.23-28.05 μg/ml), albumin 34±1 g/l (norm 40-50 g/l). After 2 hours of treatment, there was a decrease in kappa FLC concentration with HDF (-34±33%, p=0.01) and with Expanded HD (-31±12%, p<0.001), but not with conventional HD (-1±7, p=0.79, Fig 1). The lambda FLC concentration also decreased with HDF (-41±29%, p=0.01) and with Expanded HD (-28±22%, p=0.01), but not with conventional HD (-3±12, p=0.65, Fig 2). Albumin concentrations did not change significantly with any of the treatments. Conclusion Expanded HD, as well as high-flow HDF, helps to reduce the FLC concentration in patients with cast nephropathy without loss of albumin, which may have a positive effect on the multiple myeloma prognosis. Further studies are needed regarding possibilities of using Expanded HD in the complex therapy for patients with AKI in myeloma cast nephropathy.

Sign in / Sign up

Export Citation Format

Share Document