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Cesar BN, Braga WMT, Hamerschlak N, Junior MDSD. Kidney function in newly diagnosed myeloma patients: factors associated with kidney impairment and recovery. BMC Nephrol 2024; 25:344. [PMID: 39390432 PMCID: PMC11468068 DOI: 10.1186/s12882-024-03717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/16/2024] [Indexed: 10/12/2024] Open
Abstract
Kidney disease is a common complication of multiple myeloma (MM) and a risk factor for increased morbimortality. In this retrospective cohort study based on medical records, we analyzed the kidney function of patients with renal disease related to MM during the first year of treatment. All patients included were consecutively admitted to the outpatient services of two hospitals between January 2009 and January 2019 and met the diagnostic criteria for MM regardless of the reason for seeking medical help. We excluded patients who had kidney disease or who were on dialysis before MM diagnosis. We investigated the factors associated with renal function recovery using multivariate analysis. We evaluated 167 patients (median age of 66 ± 11.49 years). Almost half of the patients had arterial hypertension (76; 45.5%). The majority had International Staging System (ISS) grades 3 (73; 43.7%) or 2 (60; 35.9%). Seventy-four (44%) patients had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² at the time of MM diagnosis. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). After 12 months, 4 (2.3%) patients needed dialysis, and 18 (10.7%) died. The factors associated with an eGFR < 60 ml/min/1.73 m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 g, and extramedullary plasmacytoma. However, only baseline renal function (eGFR > 60 ml/min/1.73 m2) and HSCT were associated with greater recovery of renal function at 12 months of follow-up.
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Affiliation(s)
- Bruno Nogueira Cesar
- Nephrology Division, Federal University of Sao Paulo, Universidade Federal de São Paulo (UNIFESP), Botucatu street - cj. 153, n° 591, 15th floor - Vila Clementino, Sao Paulo, 04023-062, SP, Brazil.
| | | | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Marcelino de Souza Durão Junior
- Nephrology Division, Federal University of Sao Paulo and Kidney Transplant Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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2
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Wu F, Wang S, Zhang J, Wang P, Zhang A. Prevalence of kidney disease in patients with different types of cancer or hematological malignancies: a cross-sectional study. Int Urol Nephrol 2024:10.1007/s11255-024-04130-5. [PMID: 38916787 DOI: 10.1007/s11255-024-04130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE This study investigated the prevalence and risk factors of acute kidney injury (AKI) and chronic kidney disease (CKD) in cancer patients with the aim of providing guidance for clinical treatment of cancer patients. METHODS A retrospective study was conducted on all cancer and hematological malignancy patients admitted to Xuanwu Hospital, Capital Medical University, from January 2018 to July 2023. The study population included patients aged 18-80 years with a confirmed cancer or malignancy diagnosis. Chi-square tests, Spearman's correlation, and logistic regression were used to evaluate the relationships between demographic factors, comorbidities, cancer types, antitumor drugs and the prevalence of AKI/CKD. RESULTS Among the 2438 participants, the prevalence rates of AKI and CKD were 3.69% and 7.88%, respectively. Patients with diabetes had higher prevalence of AKI/CKD than those without diabetes (OR = 1.66, 95% CI 1.01-2.68, p = 0.040; OR = 1.60, 95% CI 1.10-2.31, p = 0.012, respectively). In addition, a higher prevalence of CKD was observed in patients with hypertension (OR = 3.49, 95% CI 2.43-5.06, p < 0.001). Underweight patients were more likely to develop AKI (OR = 2.66, 95% CI 1.03-6.08, p = 0.029). Anthracyclines may contribute to a higher risk of AKI, and antimetabolites and immunomodulators may be associated with the development of CKD. Overall, patients with hematological malignancies had significantly higher rates of AKI/CKD than those with solid tumors. Among solid tumor patients, the prevalence of AKI/CKD was low in patients with lung and breast cancer. CONCLUSIONS AKI and CKD prevalence varies across cancer types, influenced by factors, such as diabetes, hypertension, body weight, and antitumor drugs. Tailored treatment plans are essential for improving cancer patient outcomes.
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Affiliation(s)
- Feng Wu
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Changchun Street 45#, Beijing, 100053, China
| | - Shiyuan Wang
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Changchun Street 45#, Beijing, 100053, China
| | - Jialing Zhang
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Changchun Street 45#, Beijing, 100053, China
| | - Peixin Wang
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Changchun Street 45#, Beijing, 100053, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Changchun Street 45#, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China.
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3
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Ng JH, Izard S, Murakami N, Jhaveri KD, Sharma A, Nair V. Outcomes of kidney transplantation in patients with myeloma and amyloidosis in the USA. Nephrol Dial Transplant 2022; 37:2569-2580. [PMID: 35687020 PMCID: PMC9681913 DOI: 10.1093/ndt/gfac196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent improvement in treatment and patient survival has opened the eligibility of kidney transplantation to patients who developed end-stage kidney disease (ESKD) from plasma cell dyscrasias (PCDs). Data on clinical outcomes in this population are lacking. METHODS We conducted a retrospective study of United Network for Organ Sharing/Organ Procurement and Transplantation Network dataset (2006-2018) to compare patient and graft outcomes of kidney transplant recipients with ESKD due to PCD versus other causes. RESULTS Among 168 369 adult first kidney transplant recipients, 0.22-0.43% per year had PCD as the cause of ESKD. The PCD group had worse survival than the non-PCD group for both living and deceased donor types {adjusted hazard ratio [aHR] 2.24 [95% confidence interval (CI) 1.67-2.99] and aHR 1.40 [95% CI 1.08-1.83], respectively}. The PCD group had worse survival than the diabetes group, but only among living donors [aHR 1.87 (95% CI 1.37-2.53) versus aHR 1.16 (95% CI 0.89-1.2)]. Graft survival in patients with PCD were worse than non-PCD in both living and deceased donors [aHR 1.72 (95% CI 1.91-2.56) and aHR 1.30 (95% CI 1.03-1.66)]. Patient and graft survival were worse in amyloidosis but not statistically different in multiple myeloma compared with the non-PCD group. CONCLUSION The study data are crucial when determining kidney transplant eligibility and when discussing transplant risks in patients with PCD.
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Affiliation(s)
- Jia H Ng
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Stephanie Izard
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Naoka Murakami
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Amy Sharma
- Northwell Cancer Institute, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
- New affiliation as of June 2022. Montefiore Medical Center, Department of Hematology and Oncology, NY, USA
| | - Vinay Nair
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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Abstract
Cancer remains a significant cause of morbidity and mortality in kidney transplant recipients, due to long-term immunosuppression. Salient issues to consider in decreasing the burden of malignancy among kidney transplant recipients include pretransplant recipient evaluation, post-transplant screening and monitoring, and optimal treatment strategies for the kidney transplant recipients with cancer. In this review, we address cancer incidence and outcomes, approaches to cancer screening and monitoring pretransplant and post-transplant, as well as treatment strategies, immunosuppressive management, and multidisciplinary approaches in the kidney transplant recipients with cancer.
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Bujarski S, Udd K, Soof C, Chen H, Spektor TM, Safaie T, Li M, Stern J, Wang C, Xu N, Emamy-Sadr M, Swift R, Rahbari A, Patil S, Souther E, Regidor B, Sutanto C, Berenson JR. Baseline and Changes in Serum B-Cell Maturation Antigen Levels Rapidly Indicate Changes in Clinical Status Among Patients with Relapsed/Refractory Multiple Myeloma Starting New Therapy. Target Oncol 2021; 16:503-515. [PMID: 34097243 DOI: 10.1007/s11523-021-00821-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND B-cell maturation antigen (BCMA) is expressed on malignant plasma cells from patients with multiple myeloma (MM). These patients have higher levels of serum (s)BCMA than healthy subjects, and levels correlate with disease status. The half-life of sBCMA is only 24-36 h, and levels are independent of renal function. OBJECTIVE We determined whether baseline sBCMA values, a ≥ 25% increase, and a ≥ 50% decrease during treatment predicted progression-free survival (PFS) and overall survival (OS) among 81 patients with relapsed/refractory MM (RRMM) starting new treatments. METHODS Serum was obtained on day 22 of each patient's 28-day cycle of new therapy. Kaplan-Meier survival analysis and log-rank comparison tests were used to determine the effect of baseline sBCMA. The effect of percentage change in sBCMA was investigated using time-dependent Cox proportional hazard models. RESULTS Patients with baseline sBCMA levels above the median had a shorter PFS (p = 0.0077), and those in the highest quartile had a shorter PFS (p = 0.0012) and OS (p = 0.0022). A ≥ 25% increase at week 4, week 8, and anytime through week 12 predicted a shorter PFS (p = 0.0011, p = 0.0005, and p < 0.0001, respectively). A ≥ 50% decrease at week 4, week 8, and anytime through week 12 predicted a longer PFS (p = 0.0045, p = 0.029, p = 0.0055, respectively). A ≥ 25% increase in sBCMA occurred before progression according to International Myeloma Working Group criteria in 67.5% of patients. CONCLUSIONS Our results indicate the potential for the use of sBCMA as a new biomarker for monitoring patients with RRMM.
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Affiliation(s)
- Sean Bujarski
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
- James R Berenson MD, Inc., West Hollywood, CA, USA
| | - Kyle Udd
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
- James R Berenson MD, Inc., West Hollywood, CA, USA
| | | | - Haiming Chen
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | | | | | - Mingjie Li
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | - Joshua Stern
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | - Cathy Wang
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | - Ning Xu
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | | | - Regina Swift
- James R Berenson MD, Inc., West Hollywood, CA, USA
| | - Ashkon Rahbari
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | - Saurabh Patil
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA
| | | | | | | | - James R Berenson
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd., Ste. 300, West Hollywood, CA, 90069, USA.
- James R Berenson MD, Inc., West Hollywood, CA, USA.
- ONCOtherapuetics, West Hollywood, CA, USA.
- ONCOtracker, West Hollywood, CA, USA.
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Perez-Villa F, Lafage-Proust MH, Gielen E, Ortiz A, Spasovski G, Argilés À. The renal patient seen by non-renal physicians: the kidney embedded in the 'milieu intérieur'. Clin Kidney J 2021; 14:1077-1087. [PMID: 34094517 PMCID: PMC8173597 DOI: 10.1093/ckj/sfaa234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease is defined as a decrease in renal function or evidence of kidney injury for >3 months. This represents an oversimplification that may confuse physicians. Thus kidney function is equated to glomerular filtration rate, which represents one of multiple kidney functions. Some potentially more important renal functions are lost earlier, such as the production for the anti-ageing factor Klotho. Overall, these changes modify the emergent properties of the body, altering the relationships between different organs and systems, in a manner that is difficult to predict the response to interventions based on normal physiology concepts, as there is a novel steady state of interorgan relations. In this regard we now discuss the impact of CKD on heart failure; osteomuscular and joint pain and bone fragility and fractures; and osteosarcopaenia as seen by a cardiologist, a rheumatologist and a geriatrician.
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Affiliation(s)
| | | | - Eveline Gielen
- Department of Geriatrics and Centre for Metabolic Bone Diseases, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Alberto Ortiz
- Departamento de Nefrologia e Hipertensión, Laura BaderInstituto de Investigación Sanitaria de la-Fundación Jimenez Diaz Universidad Autónoma de Madrid, Madrid, Spain
| | - Goce Spasovski
- Department of Nephrology, University Hospital, Skopje, Macedonia
| | - Àngel Argilés
- RD-Néphrologie, Montpellier, France
- Bio-Communication Cardio-Métabolique EA7288, Université de Montpellier, Montpellier, France
- Néphrologie Dialyse St Guilhem, Sète, France
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7
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Li S, Gong T, Kou C, Fu A, Bolanos R, Liu J. Clinical Outcomes Associated With Chronic Kidney Disease in Elderly Medicare Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:401-412.e24. [PMID: 33658169 DOI: 10.1016/j.clml.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common in patients with multiple myeloma (MM) and is associated with a poor prognosis. We assessed CKD-associated clinical outcomes among elderly patients with MM initiating chemotherapy in the United States. MATERIALS AND METHODS We identified elderly Medicare beneficiaries (≥66 years) diagnosed with MM who initiated first-line therapy from 2008 to 2014. We identified CKD using diagnosis codes. We followed patients for death, time to next treatment (TTNT), and myeloma-defining events (anemia, hypercalcemia, skeletal-related events, progression to/of CKD) until September 30, 2015. We estimated overall survival, TTNT, and cumulative incidence of myeloma-defining events using the Kaplan-Meier method and risk of CKD-associated outcomes using Cox proportional hazards models, adjusting for demographics and comorbid conditions. RESULTS Of 22,484 included patients, 8704 (39%) had CKD at first-line therapy initiation. Compared with patients without CKD, patients with CKD had shorter median overall survival (2.1 vs. 3.6 years) and median TTNT (10.0 vs. 12.4, 9.7 vs. 11.2, 8.3 vs. 9.2, and 6.9 vs. 8.3 months at first- to fourth-line therapy). Probability of CKD progression for patients at stages 1 to 5 was higher than the probability of developing CKD for patients without CKD (3-year cumulative incidence [95% confidence interval, CI], 47% [45-48%] vs. 27% [24-26%]). Adjusted hazard ratios for CKD versus non-CKD were: all-cause death, 1.23 (95% CI, 1.18-1.28); anemia, 1.34 (95% CI, 1.24-1.45); hypercalcemia, 1.23 (95% CI, 1.09-1.38); skeletal-related events, 0.85 (95% CI, 0.90-0.91); and TTNT, from 1.03 (95% CI, 0.96-1.10) at third-line therapy to 1.15 (95% CI, 1.04-1.27) at fourth-line therapy. CONCLUSION Data from the study suggest that CKD-associated clinical burden is substantial in elderly patients with MM.
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Affiliation(s)
- Shuling Li
- Chronic Disease Research Group, Minneapolis, Minneapolis Medical Research Foundation, Minneapolis, MN.
| | - Tingting Gong
- Chronic Disease Research Group, Minneapolis, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Chuanyu Kou
- Chronic Disease Research Group, Minneapolis, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Alan Fu
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA
| | - Rachel Bolanos
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA
| | - Jiannong Liu
- Chronic Disease Research Group, Minneapolis, Minneapolis Medical Research Foundation, Minneapolis, MN
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8
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Chitty DW, Hartley-Brown MA, Abate M, Thakur R, Wanchoo R, Jhaveri KD, Nair V. Kidney transplantation in patients with multiple myeloma: narrative analysis and review of the last 2 decades. Nephrol Dial Transplant 2020; 37:1616-1626. [PMID: 33295615 DOI: 10.1093/ndt/gfaa361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 12/17/2022] Open
Abstract
There have been significant advances in the treatment of multiple myeloma in the last 2 decades. Approximately 25% of patients with newly diagnosed myeloma have some degree of kidney impairment. During the course of illness, nearly 50% of myeloma patients will develop kidney disease. Moreover, approximately 10% of myeloma patients have advanced kidney disease requiring dialysis at presentation. Hemodialysis is associated with a significantly reduced overall survival. In the setting of prolonged long-term overall survival due to the use of newer immunotherapeutic agents in the treatment of myeloma, patients with myeloma and advanced kidney disease may benefit from more aggressive management with kidney transplantation. Unfortunately, most data regarding outcomes of kidney transplantation in patients with myeloma come from single center case series. With the advent of novel treatment choices, it remains unclear if outcomes of kidney transplant recipients with myeloma have improved in recent years. In this descriptive systematic review, we coalesced published patient data over the last 20 years to help inform clinicians and patients on expected hematologic and kidney transplant outcomes in this complex population. We further discuss the future of kidney transplantation in patients with paraproteinemia.
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Affiliation(s)
- David W Chitty
- Divisions of Hematology-Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA.,Northwell Health Cancer Institute, Hematology/Medical Oncology, New Hyde Park, New York, USA
| | - Monique A Hartley-Brown
- Divisions of Hematology-Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA.,Northwell Health Cancer Institute, Hematology/Medical Oncology, New Hyde Park, New York, USA
| | - Mersema Abate
- Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Richa Thakur
- Divisions of Hematology-Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA.,Northwell Health Cancer Institute, Hematology/Medical Oncology, New Hyde Park, New York, USA
| | - Rimda Wanchoo
- Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Kenar D Jhaveri
- Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Vinay Nair
- Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
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9
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Kritmetapak K, Dumrongsukit S, Jinchai J, Wongprommek P. Pseudohyperphosphatemia in a patient with relapsed multiple myeloma after bone marrow transplantation: A case report. Clin Case Rep 2019; 7:1426-1429. [PMID: 31360504 PMCID: PMC6637355 DOI: 10.1002/ccr3.2264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022] Open
Abstract
Pseudohyperphosphatemia is a laboratory artifact characterized by falsely elevated serum phosphate mostly due to paraprotein interference on the conventional automated analyzer. Clinician recognition of this phenomenon and pre-analytical preparation, including dilution or protein precipitation, can obviate unnecessary therapy and potentially unveil the diagnosis of paraproteinemia especially related to multiple myeloma.
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Affiliation(s)
| | - Sophon Dumrongsukit
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Jittirat Jinchai
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Panibud Wongprommek
- Division of Nephrology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
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Mehtat Ünlü Ş, Özsan H, Sarıoğlu S. The Scope of Kidney Affection in Monoclonal Gammopathies at All Levels of Clinical Significance. Turk J Haematol 2017; 34:282-288. [PMID: 28832010 PMCID: PMC5774361 DOI: 10.4274/tjh.2017.0197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Multiple myeloma (MM) is one of the most important clonal malignant plasma cell disorders and renal involvement is associated with poor prognosis. Although there are several reasons for renal impairment in MM, the main cause is the toxic effects of monoclonal proteins. Although cast nephropathy is the best known and unchallenged diagnosis for hematologists and pathologists, the renal effects of monoclonal gammopathy can be various. Monoclonal gammopathy of renal significance was proposed by the International Kidney and Monoclonal Gammopathy Research Group for renal lesions in monoclonal gammopathy in recent years. Renal lesions in monoclonal gammopathy can be grouped as follows: light chain (cast) nephropathy, acute tubular injury/necrosis, tubulointerstitial nephritis, amyloidosis, monoclonal Ig deposition diseases, immunotactoid glomerulopathy, type I cryoglobulinemia, proliferative glomerulonephritis with monoclonal IgG deposits, C3 glomerulopathy with monoclonal gammopathy, and crystal-storing histiocytosis, considering the previous and new terminology. In this study, renal involvement of monoclonal gammopathies, in terms of previous and new terminology, was reviewed.
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Affiliation(s)
- Şadiye Mehtat Ünlü
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Sülen Sarıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
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11
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Howlader A, Thajudeen B, Sussman AN, Bracamonte E, Krahl L, Nasr SH. Proliferative Glomerulonephritis With Masked Monoclonal Deposits Responsive to Myeloma Therapy. Kidney Int Rep 2017; 2:1233-1237. [PMID: 29270532 PMCID: PMC5733756 DOI: 10.1016/j.ekir.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Anjuman Howlader
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Bijin Thajudeen
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
- Correspondence: Bijin Thajudeen, MD, Banner University of Arizona Medical Center, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.Banner University of Arizona Medical Center1501 N. Campbell AvenueTucsonAZ 85724USA
| | - Amy N. Sussman
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Leslie Krahl
- Department of Pathology, Banner University Medical Center, Phoenix, AZ, USA
| | - Samih H. Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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12
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Stankovikj S, Martinova K. Acute complications in multiple myeloma. SANAMED 2017. [DOI: 10.24125/sanamed.v12i2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Multiple myeloma is a malignant disorder of plasma cells, characterized by uncontrolled and progressive proliferation of a single clone of plasma cells. The disease leads to progressive morbidity and eventual mortality by lowering resistance to infection and causing significant skeletal destruction with bone pain, pathological fractures and hypercalcemia. Improved understanding of the multiple myeloma biology along with the discovery of novel anti-myeloma agents has led to a better-quality treatment of these patients. However, it still remains an incurable disease for the vast majority of patients, with a median survival 2-3 years. Patients with multiple myeloma frequently develop complications that are reason for early mortality within 60 days of diagnosis. Acute complications such as hyperviscosity syndrome, hypercalcemia, spinal cord compression, early infection, bone disease and renal impairment may be life-threatening. The treatment of these medical emergencies has greatly decreased morbidity and early mortality in patients.
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13
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Bhowmik D, Yadav S, Kumar L, Agarwal S, Agarwal SK, Gupta S. Sequential, Autologous Hematopoietic Stem Cell Transplant Followed by Renal Transplant in Multiple Myeloma. Indian J Nephrol 2017; 27:324-326. [PMID: 28761239 PMCID: PMC5514833 DOI: 10.4103/ijn.ijn_169_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 30-year-old female was symptomatic with headache, fatigue, and weakness since October 2011 and was told to have anemia. In January 2012, she was admitted outside with pulmonary edema. Investigations revealed advanced azotemia, anemia, and hypercalcemia. Urine showed 2 + proteins and 30–35 red blood cells. There was no history of oral ulcers, rash, Raynaud's phenomenon, or hemoptysis. She was evaluated for causes of rapidly progressive “renal failure.” Hemolytic work-up; antinuclear antibody, double-stranded DNA, and anti-neutrophil cytoplasmic antibody were negative. Kidney biopsy was done and interpreted as acute interstitial nephritis with hyaline casts. She was started on hemodialysis and treated with steroids and cyclophosphamide. She came to our institute in January 2012. Investigations showed evidence of paraproteinemia with kappa restriction. Bone marrow showed 15% plasma cells. Kidney biopsy was reviewed and was diagnostic of cast nephropathy. She was treated with 6 monthly cycles of dexamethasone and bortezomib. She achieved complete remission in July 2012. Maintenance doses of bortezomib were continued until May 2014. Autologous bone marrow transplantation was performed on June 06, 2014. Monthly, bortezomib was continued till April 2015. Subsequently, workup for renal transplantation was started with her father as her donor. Test for sensitization was negative. Renal transplantation was done on January 1, 2016, with prednisolone, mycophenolate, and tacrolimus. She achieved a serum creatinine of 0.6 mg% on the 4th postoperative day. Thereafter, she continues to remain stable.
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Affiliation(s)
- D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Yadav
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - L Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Agarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Senapedis WT, Baloglu E, Landesman Y. Clinical translation of nuclear export inhibitors in cancer. Semin Cancer Biol 2014; 27:74-86. [DOI: 10.1016/j.semcancer.2014.04.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/10/2014] [Indexed: 01/18/2023]
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