Clin J Am Soc Nephrol. A year-old woman was admitted to our hospital for the evaluation of the chief complaints of general fatigue and appetite loss. J Am Soc Nephrol. You are commenting using your Facebook account. Fill in your details below or click an icon to log in: She was discharged from our hospital and continued bortezomib and dexamethasone in an outpatient setting for a total of four courses; hematopoietic stem cells were then harvested from the patient. A treatment breakthrough occurred with the clinical use of bortezomib as the first proteasome inhibitor.
Plasmapheresis has been suggested as an adjunct to chemotherapy to halt or reverse renal injury associated with multiple myeloma. 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. N Engl J Med. In patients who have this biopsy-proven finding, plasmapheresis should strongly be considered as an adjunctive therapy to chemotherapy. The guidelines of the American Apheresis Association classify this combined therapy as category II and grade 2B [ 16 ]. Randomized controlled trials involving bortezomib and dexamethasone therapy with and without PE are needed.
A year-old woman was admitted to our plasmappheresis for the evaluation of the chief complaints of general fatigue and appetite loss.
In the conclusion, kidney dysfunction in patients with multiple myeloma is an emergent clinical presentation.
She had severe anemia, with a hemoglobin level of 7. Renal manifestations of plasma cell disorders. Due to its non-selectivity, PE with albumin replacement carries the risk of fibrinogen loss, leading to bleeding. This peptide, delivered by intraperitoneal induction, inhibited cast formation in the rat model. Myeloma cast nephropathy, Free light chain, Selective plasma exchange.
Light chain-induced acute renal failure can be reversed by bortezomib—doxorubicin—dexamethasone in multiple myeloma: 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. Therefore, the principles of the treatment of myeloma cast nephropathy are the elimination of FLCs and restriction of FLC production using chemotherapy [ 12 ].
Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. The difference in the volume of distribution between them is negligible.
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In addition, Hutchison et al. N Engl J Med. A breakthrough occurred with the clinical use of bortezomib as the first proteasome inhibitor. Learn how your comment data is processed. Ten days after admission, bortezomib-based chemotherapy with selective PE achieved rapid and thorough plaamapheresis light-chain FLC reduction; within a month, her kidney function had been plawmapheresis creatinine level, 1. Her body temperature was 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.
J Am Soc Nephrol.
Explanations of the mechanism of kidney dysfunction in myeloma have been based on by two major theories. However, PE with albumin replacement carried the risk of bleeding after kidney biopsy.
Post was not sent – check your email addresses! Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains. 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 ].
Published online Aug Human rights All procedures performed in studies involving this participant was in accordance with the ethical standards of the institutional bephropathy national research committee at which the studies were conducted and with the Helsinki declaration and its later amendments or comparable ethical standards.
Localization of a single binding site for immunoglobulin light chains on human Tamm—Horsfall glycoprotein. Leung N, Rajkumar SV.
Myeloma cast nephropathy caused by numerous monoclonal free light chains FLCs is a major phenotype involving the kidney [ 4 ]. In our case, no electrolytic or glucose imbalance was observed, but the pathological features revealed broad interstitial fibrosis and tubular atrophy, with infiltration of numerous macrophages. Thus, the patient was diagnosed with myeloma cast nephropathy and diabetic nephropathy.
Yes, if patients are developing AKI as a result of myeloma renal biopsy should be pursued to confirm whether myeloma cast nephropathy is present.
Plasmapheresis in cast nephropathy: yes or no?
Compliance with ethical standards Conflict of interest All the authors have declared no competing interest. This case was compatible with myeloma cast nephropathy; however, the glomerular lesions had several differential diagnoses, including amyloid light-chain AL amyloidosis, monoclonal immunoglobulin myelomaa disease MIDDproliferative glomerulonephritis with monoclonal immunoglobulin deposition PGNMIDand diabetic nephropathy.
Received Apr 11; Accepted Aug 3. Five months before admission, her serum calcium and creatinine levels had increased to To our knowledge there is not a difference between treatment with plasma exchange in lambda vs.
Plasmapheresis in myeloma cast nephropathy.
mmyeloma Renal improvement in myeloma with bortezomib plus plasma exchange. Am J Kidney Dis. Randomized controlled trials involving bortezomib and dexamethasone therapy with and without PE are needed.
However, the role of plasmapheresis in improving renal prognosis and patient survival remains to be demonstrated. A treatment breakthrough occurred with the clinical use of bortezomib as the first proteasome inhibitor. Moreover, detailed analysis by electron microscopy showed no evidence of dense deposition, but very thick glomerular membrane, suggesting diabetic nephropathy.