Case report A year-old woman was admitted to our hospital for the evaluation of the chief complaints of general fatigue and appetite loss. N Engl J Med. The patient was immediately initiated with the proteasome inhibitor bortezomib, cyclophosphamide, and dexamethasone, but because her presenting creatinine was 8. However, patients with renal failure who do not recover independent renal function continue to have very poor prognosis. We are presenting a case of a year-old woman who initially presented with findings of pre-renal AKI that did not resolve after a few days of intravenous hydration. Recent evidence has shown that bortezomib-based chemotherapy with plasma exchange PE results in a better outcome, and the authors of these studies emphasized the importance of early induction therapy [ 5 , 6 ].
A year-old woman who had a year history of type II diabetes mellitus was admitted to our hospital for the evaluation of hypercalcemia, severe kidney dysfunction, and anemia. Taken together, these findings led to the diagnosis of the patient with myeloma cast nephropathy and diabetic nephropathy with nodular lesion. Thus, the patient was diagnosed with myeloma cast nephropathy and diabetic nephropathy. Light chain-induced acute renal failure can be reversed by bortezomib—doxorubicin—dexamethasone in multiple myeloma: Randomized controlled trials involving bortezomib and dexamethasone therapy with and without PE are needed. Recent evidence has demonstrated that the earlier induction of bortezomib-based chemotherapy with plasma exchange PE provides better results for kidney function and patient survival.
Published online Aug However, it is not currently in clinical use. She had severe anemia, with a hemoglobin level of 7.
Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Early reduction of serum-free light chains associates with renal recovery in myeloma kidney.
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 jephropathy use. Abstract Myeloma cast nephropathy is a major complication of multiple myeloma. She had a serum creatinine level of 0.
SCM Plasmapheresis and Cast Nephropathy: Does It Help? – AJKD Blog
The second theory involves the binding of excess FLCs nephropatjy Tamm—Horsfall protein, which increases intratubular pressure, induces the reduction of the glomerular filtration rate, and enhances the aggregation of macrophages, which promote the inflammatory process [ 3 ]. Myeloma cast nephropathy caused by numerous monoclonal free light chains FLCs is a major phenotype involving the kidney [ 4 ].
Clinicopathologic correlations in multiple myeloma: Among these factors, renal failure is the most important prognostic factor associated with patient survival [ 3 ]. She had hypercalcemia s-cCa, Ultimately, patients that obtain myeloma remission, will move on to a bone marrow transplant where a preserved renal function will better serve them.
Hypercalcemia, renal failure, anemia, and bone myelpma CRAB are the four distinctive features of multiple myeloma. Taken together, these findings led to the diagnosis of the patient with myeloma cast nephropathy and diabetic nephropathy with plasmalheresis lesion. Three different treatment approaches have been considered: This peptide, delivered by intraperitoneal induction, inhibited cast formation in the rat model. Ten days after admission, bortezomib-based chemotherapy with selective PE achieved rapid and thorough free light-chain FLC reduction; within a month, her kidney function had been recovered creatinine level, 1.
This site uses Akismet to reduce spam. She had a year history of type II diabetes mellitus, hypertension, and hyperuricemia. Does plasmapheresis have better response with a lambda based myeloma compared to kappa?
Light chain-induced acute renal failure can be reversed by bortezomib—doxorubicin—dexamethasone in multiple myeloma: Subsequent kidney biopsy showed the clear presence of myeloma cast nephropathy, but glomerular nodular lesions had several differential diagnoses. Thus, the patient was diagnosed with myeloma cast nephropathy and diabetic nephropathy. We are presenting this case partially because the effect of plasmapheresis is still debated.
Plasmapheresis in myeloma cast nephropathy.
In our case, h urine collection showed that the urine total protein 5. In the plasmapheresix, kidney dysfunction in patients with multiple myeloma is an emergent clinical presentation.
A year-old woman was admitted to our hospital for the evaluation of the chief complaints of general fatigue and appetite loss.
Jpn J Clin Oncol. Recent evidence now indicates that an early and sustained reduction in circulating free light chains FLCs is associated with improved renal recovery in patients with myeloma kidney.
Myeloma cast nephropathy is a major complication of multiple myeloma. Randomized controlled trials involving bortezomib and dexamethasone therapy with and without PE are needed. Renal manifestations of plasma cell disorders. Her serum total protein concentration was A kidney biopsy was performed that had findings consistent with myeloma cast nephropathy myrloma the setting of diffuse fibrosis and tubular atrophy.
Plasmapheresis is theoretically attractive as a means of rapidly lowering serum FLC burden in the hope of reducing nephrotoxicity in patients with multiple myeloma.
Case report A year-old woman was admitted to our hospital for the evaluation of the chief complaints of general fatigue and appetite loss. Recent data showed that survival was better in patients receiving early induction therapy who had recovered kidney function than in those who had not recovered kidney function [ 14 ].
Clin J Am Soc Nephrol.