scholarly journals A Case of Cast Nephropathy Found as the Cause of Severe Renal Failure

Cureus ◽  
2021 ◽  
Author(s):  
Gen Adachi ◽  
Naoto Mouri ◽  
Ryuichi Ohta ◽  
Chiak Sano
Keyword(s):  
Renal Failure ◽  
Severe Renal Failure ◽  
Cast Nephropathy

Combined Chemotherapy and High Cut-Off Hemodialysis Improve Outcomes in Multiple Myeloma Patients with Severe Renal Failure.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3610-3610 ◽  
Author(s):  
Colin A. Hutchison ◽  
Mark Cook ◽  
Supratik Basu ◽  
Paul Cockwell ◽  
Kolitha Basnayake ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
De Novo ◽  
Renal Recovery ◽  
Severe Renal Failure ◽  
Cast Nephropathy ◽  
Kaplan Meier ◽  
Sustained Reduction ◽  
Rate Of Recovery ◽  
And Control

Abstract Irreversible acute renal failure (ARF) is associated with significantly increased morbidity and mortality in multiple myeloma (MM) patients. 10% of MM patients require dialysis support and of these 80% remain dialysis dependent. Cast nephropathy from excess serum free light chains (sFLC) accounts for approximately 70% of dialysis-dependent ARF in this setting. We recently reported preliminary studies demonstrating high cut-off hemodialysis (HCO-HD) as a novel method for FLC removal in MM patients (JASN, March, 2007). The purpose of this subsequent study was to two fold: Firstly, to determine the safety and effectiveness of HCO-HD to result in sustained reductions in sFLC concentrations in cast nephropathy patients. Secondly, to compare renal recovery rates in patients treated with FLC removal HD with a case-matched historical control population. Methods: 25 patients with dialysis dependent ARF and MM were assessed for inclusion. 3 patients were not suitable for renal biopsy. Renal biopsies demonstrated cast nephropathy in 20 of 22 patients. Only 18 patients commenced treatment as 2 were not suitable for chemotherapy. Thalidomide/dexamethasone regimes were used for patients with de novo MM and bortezomib/doxorubicin/dexamethasone for relapsing patients. FLC removal HD was undertaken using the Gambro HCO 1100™, for extended periods of 8 hours/day. Extended dialysis was supported by replacement of albumin, magnesium and calcium by protocol. Historical age matched control patients received standard high flux dialysis (n=18). Results: There were no complications related to FLC removal HD. However, 6 of the 18 patients developed infections requiring intervention. The percentage reductions, in sFLC concentrations, achieved by days 5, 12 and 21 were 54 (0–71), 66 (0–88) and 57 (0–88), respectively. There were no significant differences in presenting serum creatinine, sFLC type or concentration between the treatment and control groups. 13 of 18 patients (72%) in the treatment group became independent of dialysis versus 2 of 18 controls (11%, P<0.0001(Figure)). This historical rate of recovery is consistent with the published range of 2–20%. The 13 patients who became independent of dialysis following FLC removal HD achieved a median sustained reduction in sFLC concentrations of 86% (50–93). Their median time to independence of dialysis was 24 days (13–50) with an estimated GFR three months following commencement of treatment of 44mls/min/1.73m2 (29–60). The 5 patients who did not achieve independence had not attained sustained reductions in sFLC concentrations. 4 of these had chemotherapy withheld because of infections, the other had progressive disease not responsive to bortezomib based chemotherapy. Renal recovery was associated with improved Kaplan-Meier survival, P<0.02. Conclusion: Extended HCO-HD and effective chemotherapy resulted in rapid and sustained reductions in sFLC concentrations with no adverse events. Together, these interventions increased the rate of renal recovery in multiple myeloma patients with cast nephropathy. Figure Figure

scholarly journals Myeloma Cast Nephropathy Manifesting only as Unexplained Acute Renal Failure

2020 ◽  
Author(s):  
Sarojini Raman ◽  
Nikunj Kishore Rout
Keyword(s):  
Renal Failure ◽  
Renal Biopsy ◽  
Light Chain ◽  
Bone Marrow Aspiration ◽  
Elderly Age ◽  
Severe Renal Failure ◽  
Serum Free Light Chain ◽  
Cast Nephropathy ◽  
Organ Systems ◽  
Myeloma Cast Nephropathy

Multiple Myeloma (MM) is characterised by clonal B cell proliferation affecting elderly age group and involving various organ systems namely haematological, renal and skeletal system. Kidney may be affected in 50% of cases of MM. Though, Chronic Kidney Disease (CKD) is usually seen in MM, unusual presentations have been documented. The present case is of a 50-year-old female with complains of breathlessness and vague generalised symptoms. Routine tests showed blood urea level of 90 mg/dL and serum creatinine of 8.3 mg/dL. Further investigations revealed 24 hour protein level 48.5 gm/day, Erythrocyte Sedimentation Rate (ESR)-126 mm/1st hour, cast nephropathy in renal biopsy. Immunohistochemical (IHC) study on renal biopsy revealed kappa light chain deposits in tubules, raised kappa light chains (3280.00 mg/L) in serum Free Light Chain (FLC) assay and MM in bone marrow aspiration and biopsy study. So, MM should be considered in differential diagnosis in elderly patients presenting with acute severe renal failure.

Platelet Function and the Bleeding Time in Progressive Renal Failure

1988 ◽  
Vol 60 (01) ◽  
pp. 083-087 ◽  
Author(s):  
M P Gordge ◽  
R W Faint ◽  
P B Rylance ◽  
G H Neild
Keyword(s):  
Renal Failure ◽  
Platelet Aggregation ◽  
Platelet Function ◽  
Bleeding Time ◽  
C Reactive Protein ◽  
Severe Renal Failure ◽  
Reactive Protein ◽  
Thromboxane Production ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryBleeding time and platelet function tests were performed on 31 patients with progressive chronic renal failure (CRF) due to non-immunological (urological) causes, and compared with 22 healthy controls. Patients were classified as mild (plasma creatinine <300 μmol/l), moderate (300-600 μmol/l) or severe renal failure (>600 μmol/l). Bleeding time was rarely prolonged in mild and moderate CRF and mean bleeding time significantly elevated only in severe CRF (p <0.005). Haematocrit was the only index which correlated with bleeding time (r = -0.40). Platelet counts, collagen stimulated thromboxane generation, and platelet aggregation responses to ADP, collagen and ristocetin were all either normal or increased in all three CRF groups, but thromboxane production in clotting blood was reduced. Plasma fibrinogen, C reactive protein and von Willebrand factor (vWF) were elevated in proportion to CRF. We found no evidence that defects in platelet aggregation or platelet interaction with vWF prolong the bleeding time in patients with progressive CRF.

scholarly journals Neonatal Atypical Hemolytic Uremic Syndrome in the Eculizumab Era

2021 ◽  
Vol 11 (02) ◽  
pp. e95-e98
Author(s):  
Sara Madureira Gomes ◽  
Rita Pissarra Teixeira ◽  
Gustavo Rocha ◽  
Paulo Soares ◽  
Hercilia Guimaraes ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Hemolytic Uremic Syndrome ◽  
Perinatal Asphyxia ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Congenital Infection ◽  
High Morbidity ◽  
Severe Renal Failure ◽  
Emergency Cesarean ◽  
Uremic Syndrome

AbstractThe atypical hemolytic uremic syndrome (aHUS) in the newborn is a rare disease, with high morbidity. Eculizumab, considered a first-line drug in older children, is not approved in neonates and in children weighing less than 5 kg. We present a 5-day-old female newborn, born at 36 weeks' twin gestation, by emergency cesarean section due to cord prolapse, with birth weight of 2,035 g and Apgar score of 7/7/7, who develops microangiopathic hemolytic anemia, thrombocytopenia, and progressive acute renal failure. In day 5, after diagnosis of aHUS, a daily infusion of fresh frozen plasma begins, with improvement of thrombocytopenia and very slight improvement in renal function. The etiologic study (congenital infection, Shiga toxin, ADAMTS13 activity, directed metabolic study) was normal. C3c was slightly decreased. On day 16 for maintenance of anemia and severe renal failure, she started 300 mg/dose eculizumab. Anemia resolves in 10 weeks and creatinine has normal values after 13 weeks of treatment. The genetic study was normal. In this case, eculizumab is effective in controlling microangiopathy and in the recovery of renal function. Diagnosis of neonatal aHUS can be challenging because of phenotypic heterogeneity and potential overlap with other manifestations that may confound it, such as perinatal asphyxia or sepsis/disseminated intravascular coagulation.

scholarly journals Temporal trends in treatment and outcomes of patients with acute coronary syndrome and concomitant moderate to severe renal failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bossard ◽  
F Witassek ◽  
D Radovanovic ◽  
F Moccetti ◽  
P Erne ◽  
...  
Keyword(s):  
Renal Failure ◽  
Temporal Trends ◽  
Limited Information ◽  
Severe Renal Failure ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
To Receive

Abstract Introduction Limited information about the management and outcomes of patients with acute coronary syndromes (ACS) and moderate to severe renal failure (RF) is available owing to underrepresentation of this population in most studies. Methods We evaluated the use of guideline-recommended therapies and in-hospital outcomes of totally 49'191 ACS patients with normal-mild renal failure (RF) (defined as eGFR &gt;45ml/min/m2) versus moderate-severe RF (eGFR &lt;45ml/min/m2) enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2002 and 2019 according to 2-year periods. Results Overall, 3'478 (7.1%) patients had moderate-severe RF. They were older (65.2+12.9 versus 77.2+10.6 years) and had significantly more comorbidities (including heart failure, cerebrovascular and peripheral vascular disease). Moderate-severe RF patients received less frequently guideline-recommended drugs, including P2Y12 inhibitors, ACEI/ARBs and statins (p&lt;0.0001). Between the first and last 2-year periods, the number of patients with moderate-severe RF and number of performed percutaneous coronary interventions (PCI) increased in this cohort (p-for-trend=0.001). At the same time, in-hospital mortality significantly decreased among ACS patients with and without RF (17.5% to 10.5% and 6.0% to 3.9%, respectively, p-for-trend=0.001 for both, see Figure). Similar trends were observed for other complications, namely cardiogenic shock and reinfarction. However, major bleedings increased significantly over time in patients with and without RF (p-for-trend=0.038 and &lt;0.001, respectively). Conclusions Outcomes of ACS patients with moderate to severe RF improved over the last two decades. Even though the rate of PCI increased in ACS patients with moderate-severe RF, they were less likely to receive guideline-recommended therapies and still suffer a high in-hospitality mortality (&gt;10%). With respect to the increasing burden of ACS patients with RF, our study implicates that more efforts should be undertaken to further improve outcomes of those patients. Funding Acknowledgement Type of funding source: None

Benign monoclonal gammopathy presenting with severe renal failure

2009 ◽  
Vol 36 (1) ◽  
pp. 115-117 ◽  
Author(s):  
Paolo Gavarotti ◽  
Felice Fortina ◽  
Daniela Costa ◽  
Giuseppe Verzetti ◽  
Valter Redoglia ◽  
...  
Keyword(s):  
Renal Failure ◽  
Monoclonal Gammopathy ◽  
Severe Renal Failure ◽  
Benign Monoclonal Gammopathy

A Study on the Distribution of Body Fluids after Rapid Saline Expansion in Normal Subjects and in Patients with Renal Insufficiency: Preferential Intravascular Deposition in Renal Failure

1983 ◽  
Vol 64 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Hendrik A. Koomans ◽  
Anton B. Geers ◽  
Peter Boer ◽  
Jan C. Roos ◽  
Evert J. Dorhout Mees
Keyword(s):  
Renal Failure ◽  
Blood Volume ◽  
Plasma Volume ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Distribution Volume ◽  
Fluid Distribution ◽  
Severe Renal Failure ◽  
Control Value ◽  
Stage Renal Disease

1. The effect of rapid intravenous infusion of 25 ml of isotonic sodium chloride solution (saline)/kg body weight on extracellular fluid volume (ECFV, 82Br distribution volume), plasma volume (131I-labelled albumin distribution volume) and blood volume (from plasma volume and packed cell volume) was studied in nine normal subjects and a group of 11 patients with end-stage renal disease (ESRD). 2. Immediately after the infusion, the increases in ECFV were equal in the two groups but the increases in plasma and blood volumes were significantly larger in the patients with ESRD. .3. Ninety minutes after the end of the infusion, the blood volume/ECFV ratio was significantly decreased from the control value in the normal subjects, but slightly increased in the patients with ESRD. 4. It is concluded that in severe renal failure the control of fluid distribution is changed in a way which leads to a preferential distribution of rapidly infused saline into the intravascular compartment.

Administration of Ticarcillin to Patients with Severe Renal Failure

Chemotherapy ◽  
1974 ◽  
Vol 20 (6) ◽  
pp. 339-341 ◽  
Author(s):  
Michael Davies ◽  
John R. Morgan ◽  
Chandar Anand
Keyword(s):  
Renal Failure ◽  
Severe Renal Failure
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